MEDICARE: MR. ROCKY MANUEL VILI LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SWB20241003	NM

General Provider Information

NPI Number	:	1326719451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROCKY MANUEL VILI LMSW

Provider Business Mailing Address
First Line	:	1380 RIO RANCHO BLVD SE # 403
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-1006
Country	:	US
Telephone Number	:	505-938-0683
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 CLEVELAND HEIGHTS RD NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-1607
Country	:	US
Telephone Number	:	505-938-0683
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2021
Last Update Date	:	03/31/2026

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