Healthcare Provider Details

I. General information

NPI: 1043934862
Provider Name (Legal Business Name): NAEEMAH NICOLE REESE P-LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 09/27/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N LINCOLN STREET
DEXTER NM
88230-0159
US

IV. Provider business mailing address

1007 S PLAINS PARK DR
ROSWELL NM
88203-2517
US

V. Phone/Fax

Practice location:
  • Phone: 575-734-5420
  • Fax:
Mailing address:
  • Phone: 575-317-6119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2022-0446
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: