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General NPI Number Information
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NPI Number | 1194355974
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Entity Type | Individual
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Provider Name | NICOLE MARIE PADILLA LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/21/2020
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Last Update Date | 05/01/2024
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Provider Practice Location Address
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Address Line | 6330 RIVERSIDE PLAZA LN NW STE 260
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-2160
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Country | US
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Telephone | 505-226-2839
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Fax | 505-295-2559
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Provider Business Mailing Address
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Address Line | 652 VISTA LEJOS LN SW
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City | ALBUQUERQUE
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State | NM
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Zip | 87121-8980
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Country | US
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Telephone | 505-397-9034
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SWB-2024-0129
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License Number State | NM
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