Provider Demographics
NPI:1447555784
Name:LUCERO, LAWRENCE L (LISW)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:L
Last Name:LUCERO
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 SUMNER PL
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-2565
Mailing Address - Country:US
Mailing Address - Phone:575-312-6455
Mailing Address - Fax:
Practice Address - Street 1:6760 CORPORATE DR STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1987
Practice Address - Country:US
Practice Address - Phone:800-288-8044
Practice Address - Fax:877-782-0006
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-11351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical