Individual
KRYSTAL RACHELLE LUCERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
01 SAGEBRUSH, ISLETA, NM 87022-0000
(505) 869-4863
(505) 869-4881
Mailing address
PO BOX 640, ISLETA, NM 87022-0640
(505) 869-4863
(505) 869-4881
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
0084681
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0084681
LICENSE
NM
Enumeration date
10/16/2006
Last updated
07/08/2007
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