Healthcare Provider Details

I. General information

NPI: 1316461692
Provider Name (Legal Business Name): AUTUMN ELIZABETH LUCERO MA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 07/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 N CANTERBURY CT
BLOOMINGTON IN
47404-1500
US

IV. Provider business mailing address

12650 HAMILTON CROSSING BLVD
CARMEL IN
46032-5400
US

V. Phone/Fax

Practice location:
  • Phone: 812-650-3032
  • Fax:
Mailing address:
  • Phone: 317-249-2242
  • Fax: 317-663-1175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-17-26767
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: