Healthcare Provider Details

I. General information

NPI: 1356614820
Provider Name (Legal Business Name): JOILE RODRIGUEZ LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOILE DUARTE LMSW

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 YALE BLVD SE
ALBUQUERQUE NM
87106-4217
US

IV. Provider business mailing address

933 BRADBURY DR SE SUITE 2222
ALBUQUERQUE NM
87106-4374
US

V. Phone/Fax

Practice location:
  • Phone: 505-994-7999
  • Fax: 505-243-0366
Mailing address:
  • Phone: 505-272-3120
  • Fax: 505-272-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-08591
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: