Healthcare Provider Details

I. General information

NPI: 1649605015
Provider Name (Legal Business Name): ANDREA LYNETTE RASCON-THORPE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 CARLISLE BLVD NE, STE 210
ALBUQUERQUE NM
87107-4849
US

IV. Provider business mailing address

4308 CARLISLE BLVD NE, STE 210
ALBUQUERQUE NM
87107-4849
US

V. Phone/Fax

Practice location:
  • Phone: 505-269-7356
  • Fax: 505-247-1020
Mailing address:
  • Phone: 505-269-7356
  • Fax: 505-247-1020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-08658
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberX-08351
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: