MEDICARE: MICHELLE ENID LUCERO M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	P85622	NY

General Provider Information

NPI Number	:	1699024422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE ENID LUCERO M.S.

Provider Business Mailing Address
First Line	:	2536 ATLANTIC AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-2308
Country	:	US
Telephone Number	:	917-371-8521
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 WASHINGTON AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-6619
Country	:	US
Telephone Number	:	718-585-4307
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2012
Last Update Date	:	09/07/2012

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