Healthcare Provider Details

I. General information

NPI: 1902055429
Provider Name (Legal Business Name): NICOLE C RAMIREZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 04/30/2024
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 E HIGH ST
GRANTS NM
87020-2453
US

IV. Provider business mailing address

PO BOX 192
NEW LAGUNA NM
87038-0192
US

V. Phone/Fax

Practice location:
  • Phone: 505-658-4322
  • Fax: 505-375-2545
Mailing address:
  • Phone:
  • Fax: 505-375-2545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-10818
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: