Healthcare Provider Details

I. General information

NPI: 1447764501
Provider Name (Legal Business Name): LINNAE LUCERO M. ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 LAS LOMAS RD NE
ALBUQUERQUE NM
87102-2610
US

IV. Provider business mailing address

PO BOX 16330
ALBUQUERQUE NM
87191-6330
US

V. Phone/Fax

Practice location:
  • Phone: 505-242-2677
  • Fax:
Mailing address:
  • Phone: 505-610-2370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2023-1033
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: