Healthcare Provider Details

I. General information

NPI: 1295802635
Provider Name (Legal Business Name): ROBERTA RICE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 LOS HIJOS NW
ALBUQUERQUE NM
87114
US

IV. Provider business mailing address

PO BOX 10509
ALBUQUERQUE NM
87184-0509
US

V. Phone/Fax

Practice location:
  • Phone: 505-248-0779
  • Fax: 505-792-1399
Mailing address:
  • Phone: 505-248-0779
  • Fax: 505-792-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberNM0150
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: