Healthcare Provider Details

I. General information

NPI: 1063858702
Provider Name (Legal Business Name): REBECCA KATHLEEN DAVIS-DURAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 BARBARA LOOP SE STE 208
RIO RANCHO NM
87124-1041
US

IV. Provider business mailing address

9100 SAN MATEO BLVD NE APT 1089
ALBUQUERQUE NM
87113-2609
US

V. Phone/Fax

Practice location:
  • Phone: 505-219-1125
  • Fax:
Mailing address:
  • Phone: 505-234-4554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-10002
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-11010
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: