Healthcare Provider Details

I. General information

NPI: 1073090544
Provider Name (Legal Business Name): BOBBIE FAY LAROCQUE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4316 CARLISLE BLVD NE STE D
ALBUQUERQUE NM
87107-4829
US

IV. Provider business mailing address

PO BOX 40742
ALBUQUERQUE NM
87196-0742
US

V. Phone/Fax

Practice location:
  • Phone: 505-421-0814
  • Fax:
Mailing address:
  • Phone: 505-519-1502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2023-1308
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: