Provider Demographics
NPI:1427482256
Name:LUCERO, JEFFREY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:LUCERO
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3137
Mailing Address - Country:US
Mailing Address - Phone:178-522-4466
Mailing Address - Fax:307-459-6607
Practice Address - Street 1:20 W EMERSON ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3137
Practice Address - Country:US
Practice Address - Phone:178-522-4466
Practice Address - Fax:307-459-6607
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN280722363LP0808X
MA280722163WP0807X, 163WP0809X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400275837Medicare PIN