Healthcare Provider Details

I. General information

NPI: 1255902979
Provider Name (Legal Business Name): VYVIAN NGUYEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2021
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SUDDERTH DR
RUIDOSO NM
88345-6103
US

IV. Provider business mailing address

1400 SUDDERTH DR
RUIDOSO NM
88345-6103
US

V. Phone/Fax

Practice location:
  • Phone: 575-630-0571
  • Fax: 505-443-8326
Mailing address:
  • Phone: 575-630-0571
  • Fax: 505-443-8326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2026-0438
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: