Healthcare Provider Details

I. General information

NPI: 1194355974
Provider Name (Legal Business Name): NICOLE MARIE PADILLA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2020
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 RIVERSIDE PLAZA LN NW STE 260
ALBUQUERQUE NM
87120-2160
US

IV. Provider business mailing address

652 VISTA LEJOS LN SW
ALBUQUERQUE NM
87121-8980
US

V. Phone/Fax

Practice location:
  • Phone: 505-226-2839
  • Fax: 505-295-2559
Mailing address:
  • Phone: 505-397-9034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2024-0129
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: