Healthcare Provider Details

I. General information

NPI: 1891059424
Provider Name (Legal Business Name): REBECCA L. NEWKIRK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 ACADEMY RD NE STE 2-200
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

7801 ACADEMY RD NE STE 2-200
ALBUQUERQUE NM
87109-3380
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-9391
  • Fax: 505-265-7860
Mailing address:
  • Phone: 505-262-9391
  • Fax: 505-265-7860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-08923
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904010256
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: