Healthcare Provider Details

I. General information

NPI: 1598547846
Provider Name (Legal Business Name): SHARRAE L RODRIGUEZ MS MCHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARRAE L SMITH MS PSYCHOLOGY

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1052 MAIN ST NE STE D
LOS LUNAS NM
87031-7436
US

IV. Provider business mailing address

5328 MONTGOMERY BLVD NE APT 5307
ALBUQUERQUE NM
87109-1365
US

V. Phone/Fax

Practice location:
  • Phone: 505-864-4140
  • Fax:
Mailing address:
  • Phone: 505-409-9074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCBT20250104
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: