Provider Demographics
NPI:1801574769
Name:LUCERO, LESLIE
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:LUCERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3100
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01004-3100
Mailing Address - Country:US
Mailing Address - Phone:866-871-9807
Mailing Address - Fax:617-419-1055
Practice Address - Street 1:83 MORSE ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-4351
Practice Address - Country:US
Practice Address - Phone:866-871-9807
Practice Address - Fax:617-419-1055
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health