Healthcare Provider Details

I. General information

NPI: 1831593748
Provider Name (Legal Business Name): JORDAN ROSENBLUTH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 E LOHMAN AVE STE 209
LAS CRUCES NM
88001-3172
US

IV. Provider business mailing address

4656 VALENTINA RD
LAS CRUCES NM
88012-0855
US

V. Phone/Fax

Practice location:
  • Phone: 575-405-0047
  • Fax:
Mailing address:
  • Phone: 828-772-0128
  • Fax: 828-772-0128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2023-0994
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2025-1321
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number110666
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: