Healthcare Provider Details

I. General information

NPI: 1558089086
Provider Name (Legal Business Name): TERESA LUCERO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4851 PASEO DEL SOL
SANTA FE NM
87507-3027
US

IV. Provider business mailing address

3325 VISTA DEL PRADO CT
SANTA FE NM
87507-4884
US

V. Phone/Fax

Practice location:
  • Phone: 505-467-1000
  • Fax:
Mailing address:
  • Phone: 505-690-7523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberSWB-2022-0143
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: