Healthcare Provider Details

I. General information

NPI: 1295962702
Provider Name (Legal Business Name): LAURA RODRIGUEZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNSER BLVD SE
RIO RANCHO NM
87124-4660
US

IV. Provider business mailing address

1660 OLD PECOS TRL STE A
SANTA FE NM
87505-4779
US

V. Phone/Fax

Practice location:
  • Phone: 505-548-9023
  • Fax: 505-531-8020
Mailing address:
  • Phone: 505-548-9023
  • Fax: 505-531-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB20230429
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: