Healthcare Provider Details

I. General information

NPI: 1770713752
Provider Name (Legal Business Name): ROCHELLE ROBYN AGUILAR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROCHELLE ROBYN ATENCIO LCSW

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 CARLISLE BLVD NE STE 101
ALBUQUERQUE NM
87110-2850
US

IV. Provider business mailing address

2921 CARLISLE BLVD NE STE 101
ALBUQUERQUE NM
87110-2850
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-9769
  • Fax: 505-717-2988
Mailing address:
  • Phone: 505-888-9769
  • Fax: 505-717-2988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-08375
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: