Healthcare Provider Details

I. General information

NPI: 1114535960
Provider Name (Legal Business Name): NATALIE RENEE RODRIGUEZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 5 PTS RD SW
ALBUQUERQUE NM
87105-3179
US

IV. Provider business mailing address

1500 GOLF COURSE RD SE
RIO RANCHO NM
87124-1963
US

V. Phone/Fax

Practice location:
  • Phone: 505-715-9728
  • Fax:
Mailing address:
  • Phone: 505-715-9728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-11548
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-11548
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: