Healthcare Provider Details

I. General information

NPI: 1023799509
Provider Name (Legal Business Name): LESLIE FITZWATER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLIE RHUDY, MCDANIEL, MOORE, FAIRFIELD

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S LEA AVE # 4
ROSWELL NM
88203-4562
US

IV. Provider business mailing address

PO BOX 102
ROSWELL NM
88202-0102
US

V. Phone/Fax

Practice location:
  • Phone: 575-347-1883
  • Fax: 737-201-2725
Mailing address:
  • Phone: 575-347-1883
  • Fax: 737-201-2725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB20220948
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: