Healthcare Provider Details

I. General information

NPI: 1942941794
Provider Name (Legal Business Name): CLINICAL RITUALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 SAN CARLOS RD SW APT 7
ALBUQUERQUE NM
87104-1060
US

IV. Provider business mailing address

1405 SAN CARLOS RD SW APT 7
ALBUQUERQUE NM
87104-1060
US

V. Phone/Fax

Practice location:
  • Phone: 505-257-6868
  • 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: MILENA SUDAK
Title or Position: LCSW
Credential:
Phone: 720-495-2346