Healthcare Provider Details

I. General information

NPI: 1396979464
Provider Name (Legal Business Name): LUCINDA LEONORA PADILLA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 FIVE POINTS RD SW
ALBUQUERQUE NM
87105-3179
US

IV. Provider business mailing address

3909 JUAN TABO BLVD NE STE 4
ALBUQUERQUE NM
87111-3973
US

V. Phone/Fax

Practice location:
  • Phone: 505-242-6919
  • Fax:
Mailing address:
  • Phone: 505-332-8979
  • Fax: 505-332-8806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number5526
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-10141
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: