Healthcare Provider Details

I. General information

NPI: 1922478031
Provider Name (Legal Business Name): ROBERTO CAZE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10110 SPAIN RD NE
ALBUQUERQUE NM
87111-1965
US

IV. Provider business mailing address

10110 SPAIN RD NE
ALBUQUERQUE NM
87111-1965
US

V. Phone/Fax

Practice location:
  • Phone: 505-404-9395
  • Fax: 505-299-4740
Mailing address:
  • Phone: 505-404-9395
  • Fax: 505-299-4740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-11567
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: