Healthcare Provider Details

I. General information

NPI: 1003233669
Provider Name (Legal Business Name): MARIAH VASQUEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIAH LOPEZ

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 MOON ST NE
ALBUQUERQUE NM
87112-3935
US

IV. Provider business mailing address

6128 MURCIA AVE NW
ALBUQUERQUE NM
87114-5852
US

V. Phone/Fax

Practice location:
  • Phone: 505-271-0329
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2026-0437
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-10635
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: