Healthcare Provider Details

I. General information

NPI: 1477886414
Provider Name (Legal Business Name): SYLVIA BALTAZAR LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N PENNSYLVANIA AVE STE 670B
ROSWELL NM
88201-4755
US

IV. Provider business mailing address

1100 W. 21ST
CLOVIS NM
88101
US

V. Phone/Fax

Practice location:
  • Phone: 575-769-2345
  • Fax: 575-769-9013
Mailing address:
  • Phone: 575-769-2345
  • Fax: 575-769-9013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: