Healthcare Provider Details

I. General information

NPI: 1962954248
Provider Name (Legal Business Name): KIRSTEN LUCERO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS KIRSTEN ANNIKA LUCERO

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 CAMINO ENTRADA
SANTA FE NM
87507-4851
US

IV. Provider business mailing address

2504 CAMINO ENTRADA
SANTA FE NM
87507-4851
US

V. Phone/Fax

Practice location:
  • Phone: 505-471-5006
  • Fax:
Mailing address:
  • Phone: 505-471-5006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-11823
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: