Healthcare Provider Details

I. General information

NPI: 1174876296
Provider Name (Legal Business Name): AMANDA M LOBATO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2012
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W BROADWAY STE E&D
FARMINGTON NM
87401-5638
US

IV. Provider business mailing address

PO BOX 402
BLOOMFIELD NM
87413-0402
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-4796
  • Fax:
Mailing address:
  • Phone: 505-860-3479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09928770
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-11390
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: