Individual
LUCAS CEDRIC PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6177 N OLIVER AVE, BOISE, ID 83714-2070
(208) 954-2310
Mailing address
6177 N OLIVER AVE, BOISE, ID 83714-2070
(208) 954-2310
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
8911017
ID
Other
Enumeration date
07/23/2025
Last updated
07/23/2025
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