Healthcare Provider Details

I. General information

NPI: 1780470864
Provider Name (Legal Business Name): ALICIA HARPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICIA SAMBRANO

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 RIO GRANDE BLVD NW STE G252
ALBUQUERQUE NM
87104-2050
US

IV. Provider business mailing address

760 SAN DIEGO LOOP
JEMEZ SPRINGS NM
87025-8102
US

V. Phone/Fax

Practice location:
  • Phone: 573-280-2412
  • Fax:
Mailing address:
  • Phone: 573-280-2412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2025-1094
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: