Healthcare Provider Details

I. General information

NPI: 1043899669
Provider Name (Legal Business Name): YVONNE DUARTE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4273 MONTGOMERY BLVD NE STE K-220
ALBUQUERQUE NM
87109-6748
US

IV. Provider business mailing address

8226 MENAUL BLVD NE # 106
ALBUQUERQUE NM
87110-4614
US

V. Phone/Fax

Practice location:
  • Phone: 505-274-1012
  • Fax:
Mailing address:
  • Phone: 505-274-1012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-10970
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: