Healthcare Provider Details

I. General information

NPI: 1073796157
Provider Name (Legal Business Name): RENE VALENZUELA LACOME LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N MAIN ST
BELEN NM
87002-3720
US

IV. Provider business mailing address

520 N.MAIN ST
BELEN NM
87002-7002
US

V. Phone/Fax

Practice location:
  • Phone: 505-861-1514
  • Fax:
Mailing address:
  • Phone: 505-861-1514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberM-2555
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: