Healthcare Provider Details

I. General information

NPI: 1639549744
Provider Name (Legal Business Name): ARIA SUTTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7425 4TH ST NW
LOS RANCHOS NM
87107-6627
US

IV. Provider business mailing address

7425 4TH ST NW
LOS RANCHOS NM
87107-6627
US

V. Phone/Fax

Practice location:
  • Phone: 505-520-5101
  • Fax:
Mailing address:
  • Phone: 505-520-5101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2023-0020
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: