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NPI Code Detail

MEDICARE: MRS. THERESA ANNE ONTIVEROS LCSW, RPT

MEDICARE: MRS. THERESA ANNE ONTIVEROS LCSW, RPT
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
11041C0700XClinical Social WorkerC07151NM

General Provider Information

NPI Number : 1346378437
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. THERESA ANNE ONTIVEROS LCSW, RPT
Provider Business Mailing Address
First Line : PO BOX 405
Second Line :
City : SAN MIGUEL
State : NM
Zip : 88058-0405
Country : US
Telephone Number : 575-644-9861
Fax Number :
Provider Business Practice Location Address
First Line : 2435 S TELSHOR BLVD
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-5029
Country : US
Telephone Number : 575-323-1315
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2007
Last Update Date : 03/19/2026

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