Healthcare Provider Details

I. General information

NPI: 1417519323
Provider Name (Legal Business Name): KRISTEN ESQUIVEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 COAL AVE SE
ALBUQUERQUE NM
87108-2896
US

IV. Provider business mailing address

9536 ANDESITE DR NW
ALBUQUERQUE NM
87114-3010
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-3711
  • Fax:
Mailing address:
  • Phone: 505-702-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2024-0797
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: