Healthcare Provider Details

I. General information

NPI: 1770139529
Provider Name (Legal Business Name): LUCERO RAVE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUCY RAVE

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1354 E CHOCOLATE AVE
HERSHEY PA
17033-1116
US

IV. Provider business mailing address

200 N 7TH ST
LEBANON PA
17046-5040
US

V. Phone/Fax

Practice location:
  • Phone: 717-216-0209
  • Fax:
Mailing address:
  • Phone: 717-272-5464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW023854
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: