Healthcare Provider Details

I. General information

NPI: 1255097044
Provider Name (Legal Business Name): RONALD D'MON REID LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SUTTER PL
CLOVIS NM
88101-4611
US

IV. Provider business mailing address

PO BOX 19000
CLOVIS NM
88102-9000
US

V. Phone/Fax

Practice location:
  • Phone: 575-769-4490
  • Fax: 575-769-4430
Mailing address:
  • Phone: 575-769-4490
  • Fax: 575-769-4430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2024-0045
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-11141
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: