Healthcare Provider Details

I. General information

NPI: 1710031471
Provider Name (Legal Business Name): ELIZABETH M DELGADO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 DEBORAH RD SE SUITE 205
RIO RANCHO NM
87124-1058
US

IV. Provider business mailing address

170 ITASCA RD SE
RIO RANCHO NM
87124-2613
US

V. Phone/Fax

Practice location:
  • Phone: 505-892-4646
  • Fax: 505-892-4775
Mailing address:
  • Phone: 505-896-0933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-05457
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: