Active NPI
Steven Lucero, PHD, MBA
- Clinical Psychologist
- Logan, UT
National Provider Identifier
1205433059
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 8728523-2501
- Practice address
- 93 S 1250 E
Logan, UT 84321-6770 - Phone
- (307) 631-0148
- NPI assigned
- Oct 5, 2020
- Last updated
- Oct 5, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 8728523-2501 | UT | Primary |
Addresses
Primary practice location
93 S 1250 E
Logan, UT 84321-6770
Mailing address
93 S 1250 E
Logan, UT 84321-6770
Phone (307) 631-0148
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2013
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
169 Madison Ave
New York, NY 10016-5101
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Business Administration, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8728523-2501 | UT | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| KBS Medical New Jersey PC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Psychiatry Physician
- Hoboken, NJ
- NPI 1164123527
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1601856000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601856000000",
"number": "1205433059",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "93 S 1250 E",
"city": "LOGAN",
"state": "UT",
"postal_code": "843216770",
"telephone_number": "307-631-0148"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "93 S 1250 E",
"city": "LOGAN",
"state": "UT",
"postal_code": "843216770",
"telephone_number": "307-631-0148"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUCERO",
"first_name": "STEVEN",
"name_prefix": "Dr.",
"credential": "PHD, MBA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-10-05",
"last_updated": "2020-10-05",
"certification_date": "2020-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "UT",
"license": "8728523-2501",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Logan, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.