MEDICARE: COREY LUCERO-PERKINS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	LCS21866	CA

General Provider Information

NPI Number	:	1225115868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY LUCERO-PERKINS LCSW

Provider Business Mailing Address
First Line	:	8788 ELK GROVE BLVD # 3-20
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-1766
Country	:	US
Telephone Number	:	916-715-5128
Fax Number	:	916-226-2527

Provider Business Practice Location Address
First Line	:	8788 ELK GROVE BLVD # 3-12F
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-1766
Country	:	US
Telephone Number	:	916-715-5128
Fax Number	:	530-622-2793

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	09/23/2014

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