Individual
JUAN LUCERO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW-38062
Contact information
Practice address
412 W CENTER ST STE 300, POCATELLO, ID 83204-3238
(208) 406-9323
Mailing address
957 HIGHLAND BLVD, POCATELLO, ID 83204-4730
(208) 406-9323
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-38062
ID
Other
Enumeration date
12/03/2015
Last updated
01/07/2021
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