Facts
- Status
- A
- Credential
- LCSW
- Type
- Individual
- Enumeration date
- 2018-04-10
- Last updated
- 2026-03-03
Specialties
Licenses
- License NM
- SWB-2025-1261
Location
- Practice location
- 6501 4TH ST NW
- City
- LOS RANCHOS NM
- Postal code
- 871075800
- Phone
- 505-433-7561
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.