Healthcare Provider Details

I. General information

NPI: 1831410968
Provider Name (Legal Business Name): ANTHONY RODRIGUEZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 NM HWY 28
ANTHONY NM
88021
US

IV. Provider business mailing address

4950 MCNUTT RD
SUNLAND PARK NM
88008-9621
US

V. Phone/Fax

Practice location:
  • Phone: 575-882-6300
  • Fax:
Mailing address:
  • Phone: 575-882-6376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-08625
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: