MEDICARE: SAMANTHA LUCERO

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1235875246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA LUCERO

Provider Business Mailing Address
First Line	:	3270 DOC BAR CT
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-7241
Country	:	US
Telephone Number	:	575-642-6778
Fax Number	:

Provider Business Practice Location Address
First Line	:	3270 DOC BAR CT
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-7241
Country	:	US
Telephone Number	:	201-477-0079
Fax Number	:

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

Provider Enumeration Date	:	05/11/2022
Last Update Date	:	03/30/2026

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Directions to “ SAMANTHA LUCERO ” Practice Location

Language	Start Address	Practice Location

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