Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1174045165 |
---|---|
Provider Name | Kristine Marie Lucero |
First Address | Los Lunas, NM 87031-7019 |
Second Address | Los Lunas, NM 87031-7019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2017 |
Last Update Date | 25/01/2021 |