Healthcare Provider Details

I. General information

NPI: 1639727092
Provider Name (Legal Business Name): CASSIDY NEWTON RICE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4619 GREENE ST NW STE C
ALBUQUERQUE NM
87114-4899
US

IV. Provider business mailing address

4619 GREENE ST NW STE C
ALBUQUERQUE NM
87114-4899
US

V. Phone/Fax

Practice location:
  • Phone: 817-522-2625
  • Fax:
Mailing address:
  • Phone: 817-522-2625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number66704
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2025-0907
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: