Provider Demographics
NPI:1548969967
Name:LUCERO-ALTAMIRANO, NANCY (LLMSW)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:LUCERO-ALTAMIRANO
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15424 HULL RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-3826
Mailing Address - Country:US
Mailing Address - Phone:734-497-2951
Mailing Address - Fax:
Practice Address - Street 1:15424 HULL RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-3826
Practice Address - Country:US
Practice Address - Phone:734-497-2951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172A00000X, 171R00000X, 172V00000X, 251S00000X
MI104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No172A00000XOther Service ProvidersDriver
No171R00000XOther Service ProvidersInterpreter
No172V00000XOther Service ProvidersCommunity Health Worker
No251S00000XAgenciesCommunity/Behavioral Health