Healthcare Provider Details

I. General information

NPI: 1174294532
Provider Name (Legal Business Name): LAURA ROSS WOOD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2021
Last Update Date: 03/22/2025
Certification Date: 03/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5720 EL PRADO RD NW
LOS RANCHOS NM
87107-6310
US

IV. Provider business mailing address

5720 EL PRADO RD NW
LOS RANCHOS NM
87107-6310
US

V. Phone/Fax

Practice location:
  • Phone: 505-699-5885
  • Fax:
Mailing address:
  • Phone: 505-699-5885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2024-0211
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105759
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: