Healthcare Provider Details

I. General information

NPI: 1285002147
Provider Name (Legal Business Name): CARLA IVELISSE CINTRON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LASER RD NE
RIO RANCHO NM
87124-4517
US

IV. Provider business mailing address

1465 REYNOSA LOOP SE
RIO RANCHO NM
87124-8752
US

V. Phone/Fax

Practice location:
  • Phone: 505-896-0667
  • Fax:
Mailing address:
  • Phone: 505-977-5185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: