Healthcare Provider Details

I. General information

NPI: 1861994774
Provider Name (Legal Business Name): RAQUEL TEREZA GUZMAN VEGA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date: 10/28/2018
Reactivation Date: 08/25/2021

III. Provider practice location address

1005 21ST ST SE STE B
RIO RANCHO NM
87124-4030
US

IV. Provider business mailing address

PO BOX 15248
RIO RANCHO NM
87174-0248
US

V. Phone/Fax

Practice location:
  • Phone: 505-353-2061
  • Fax:
Mailing address:
  • Phone: 505-339-6938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSWB-2022-0803
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2024-1148
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: