Healthcare Provider Details

I. General information

NPI: 1326719451
Provider Name (Legal Business Name): ROCKY MANUEL VILI LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 CLEVELAND HEIGHTS RD NE
RIO RANCHO NM
87144-1607
US

IV. Provider business mailing address

1380 RIO RANCHO BLVD SE # 403
RIO RANCHO NM
87124-1006
US

V. Phone/Fax

Practice location:
  • Phone: 505-938-0683
  • Fax:
Mailing address:
  • Phone: 505-938-0683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB20241003
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: