Healthcare Provider Details

I. General information

NPI: 1922773043
Provider Name (Legal Business Name): MARIA L CISNEROS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 E 30TH ST STE A
FARMINGTON NM
87402-8805
US

IV. Provider business mailing address

3401 E 30TH ST STE A
FARMINGTON NM
87402-8805
US

V. Phone/Fax

Practice location:
  • Phone: 505-599-8617
  • Fax: 855-290-2205
Mailing address:
  • Phone: 505-599-8617
  • Fax: 855-290-2205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2025-0551
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: