Healthcare Provider Details

I. General information

NPI: 1437464138
Provider Name (Legal Business Name): PAULA L RALEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 MAIN STREET NE SUITE A
LOS LUNAS NM
87031
US

IV. Provider business mailing address

2441 CABEZON BLVD SE
RIO RANCHO NM
87124
US

V. Phone/Fax

Practice location:
  • Phone: 505-916-5900
  • Fax: 505-916-5901
Mailing address:
  • Phone: 505-717-1155
  • Fax: 505-717-1473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM07384
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: