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General NPI Number Information
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NPI Number | 1811172968
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Entity Type | Individual
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Provider Name | CAROL V LUCERO LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 05/19/2020
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Provider Practice Location Address
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Address Line | 6451 MCCALL ST # D
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City | BONNERS FERRY
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State | ID
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Zip | 83805-8525
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Country | US
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Telephone | 208-267-2070
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1654
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City | BONNERS FERRY
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State | ID
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Zip | 83805-1654
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Country | US
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Telephone | 208-267-5050
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LMSW26879
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCSW-31519
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License Number State | ID
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