Healthcare Provider Details

I. General information

NPI: 1174829170
Provider Name (Legal Business Name): ROXROY ANTHONY REID LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 HOMESTEAD RD NE STE 300
ALBUQUERQUE NM
87110-1524
US

IV. Provider business mailing address

100 RICHARD RD
CORRALES NM
87048-6013
US

V. Phone/Fax

Practice location:
  • Phone: 505-503-6838
  • Fax: 505-369-1292
Mailing address:
  • Phone: 505-710-4278
  • Fax: 505-369-1292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-06926
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: