Healthcare Provider Details

I. General information

NPI: 1821467374
Provider Name (Legal Business Name): ERICA MONTOYA-HEATH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 04/21/2024
Certification Date: 04/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3949 CORRALES RD STE 205
CORRALES NM
87048-9348
US

IV. Provider business mailing address

PO BOX 66861
ALBUQUERQUE NM
87193-6861
US

V. Phone/Fax

Practice location:
  • Phone: 505-385-0439
  • Fax:
Mailing address:
  • Phone: 505-918-9690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC-09226
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-09226
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: