Healthcare Provider Details

I. General information

NPI: 1942841168
Provider Name (Legal Business Name): YAHAIRA ESTRADA LMSW- PROVISIONAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 CENTRO FAMILIAR BLVD SW
ALBUQUERQUE NM
87105-4502
US

IV. Provider business mailing address

1710 CENTRO FAMILIAR BLVD SW
ALBUQUERQUE NM
87105-4502
US

V. Phone/Fax

Practice location:
  • Phone: 505-212-7405
  • Fax:
Mailing address:
  • Phone: 505-212-7405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberX-11213
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: