Healthcare Provider Details

I. General information

NPI: 1083103758
Provider Name (Legal Business Name): ANGELIQUE VICTORIA TORRES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELIQUE BACA MS

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 RAINBOW BLVD NW
ALBUQUERQUE NM
87114-6090
US

IV. Provider business mailing address

4605 DON PEDRO PADILLA RD SW
ALBUQUERQUE NM
87121-6266
US

V. Phone/Fax

Practice location:
  • Phone: 505-890-0343
  • Fax:
Mailing address:
  • Phone: 505-974-5582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberSWB-2022-1167
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB20261129
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: