Healthcare Provider Details

I. General information

NPI: 1366389462
Provider Name (Legal Business Name): MADELINE ROCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 CENTRAL AVE SW
ALBUQUERQUE NM
87102-3116
US

IV. Provider business mailing address

7708 PROSPECT AVE NE
ALBUQUERQUE NM
87110-4620
US

V. Phone/Fax

Practice location:
  • Phone: 505-243-3308
  • Fax:
Mailing address:
  • Phone: 505-388-4842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberSWB-2026-0042
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: