Healthcare Provider Details

I. General information

NPI: 1902375249
Provider Name (Legal Business Name): AVA DASYA RASA LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 N. ALAMEDA BLVD.
LAS CRUCES NM
88005
US

IV. Provider business mailing address

PO BOX 417
FAIRACIES NM
88033-0417
US

V. Phone/Fax

Practice location:
  • Phone: 575-523-3742
  • Fax:
Mailing address:
  • Phone: 575-523-3742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-12073
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-10563
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: