Healthcare Provider Details

I. General information

NPI: 1760620751
Provider Name (Legal Business Name): PEOPLEWORKS-NM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 21ST ST SE STE B
RIO RANCHO NM
87124-4030
US

IV. Provider business mailing address

1005 21ST ST SE STE B
RIO RANCHO NM
87124-4030
US

V. Phone/Fax

Practice location:
  • Phone: 505-990-4186
  • Fax: 505-897-7253
Mailing address:
  • Phone: 505-990-4186
  • Fax: 505-897-7253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CINDY V ANDERSON
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW, LCSW
Phone: 505-990-4186