Provider Demographics
NPI:1598421604
Name:ROMERO, LUCAS
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:ROMERO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 RIO RANCHO BLVD
Mailing Address - Street 2:PO BOX #403
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1006
Mailing Address - Country:US
Mailing Address - Phone:505-226-5204
Mailing Address - Fax:
Practice Address - Street 1:3636 MOON ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3295
Practice Address - Country:US
Practice Address - Phone:505-226-5204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3677861041S0200X
NMSWB-2024-10861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool