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NPI Code Detail

MEDICARE: DR. MICHELE LUCERO PSY.D.

MEDICARE: DR. MICHELE LUCERO PSY.D.
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
1103T00000XPsychologist015800-1NY

General Provider Information

NPI Number : 1962492868
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHELE LUCERO PSY.D.
Provider Business Mailing Address
First Line : PO BOX 176
Second Line :
City : FRANKLIN SQUARE
State : NY
Zip : 11010-0176
Country : US
Telephone Number : 516-510-6285
Fax Number : 516-546-1028
Provider Business Practice Location Address
First Line : 2277 GRAND AVE
Second Line :
City : BALDWIN
State : NY
Zip : 11510-3148
Country : US
Telephone Number : 516-546-6924
Fax Number : 516-546-1028
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2005
Last Update Date : 07/08/2007

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