Individual
MR. JEFFREY HENRY LUCERO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
4687 SE 1ST TERRACE, GRESHAM, OR 97080
(801) 949-2986
Mailing address
4687 SE 1ST TERRACE, GRESHAM, OR 97080
(801) 949-2986
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
4971566-3501
UT
1041C0700X
Clinical Social Worker
Primary
L8010
OR
1041C0700X
Clinical Social Worker
LCSW-34389
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
452638687
—
ID
Enumeration date
03/03/2016
Last updated
05/14/2020
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