Healthcare Provider Details

I. General information

NPI: 1932735404
Provider Name (Legal Business Name): ROSA GALLEGOS SAMORA LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 03/21/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8312 TINA DR NE
ALBUQUERQUE NM
87109-5239
US

IV. Provider business mailing address

8312 TINA DR NE
ALBUQUERQUE NM
87109-5239
US

V. Phone/Fax

Practice location:
  • Phone: 505-385-5025
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ROSA GALLEGOS SAMORA
Title or Position: OWNER
Credential:
Phone: 505-385-5025