MEDICARE: JUSTIN ARAGON LADAC, 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	104100000X	Social Worker	SWB-2026-0327	NM
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	CTB-2023-0571	NM

General Provider Information

NPI Number	:	1750080941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN ARAGON LADAC, LMSW

Provider Business Mailing Address
First Line	:	6604 PAPAGAYO RD NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-7017
Country	:	US
Telephone Number	:	505-239-2832
Fax Number	:

Provider Business Practice Location Address
First Line	:	5640 VENICE AVE NE STE L
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-2350
Country	:	US
Telephone Number	:	505-408-4280
Fax Number	:

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

Provider Enumeration Date	:	02/27/2023
Last Update Date	:	03/17/2026

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