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NPI 1295802635

NPI 1295802635 : ROBERTA RICE MSW : ALBUQUERQUE, NM

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General NPI Number Information
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    NPI Number           |    1295802635
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    Entity Type          |    Individual 
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    Provider Name        |    ROBERTA RICE MSW
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    11/29/2006
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    Last Update Date     |    09/28/2008
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Provider Practice Location Address
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    Address Line         |    604 LOS HIJOS NW 
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    City                 |    ALBUQUERQUE
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    State                |    NM
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    Zip                  |    87114
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    Country              |    US
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    Telephone            |    505-248-0779
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    Fax                  |    505-792-1399
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Provider Business Mailing Address
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    Address Line         |    PO BOX 10509 
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    City                 |    ALBUQUERQUE
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    State                |    NM
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    Zip                  |    87184-0509
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    Country              |    US
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    Telephone            |    505-248-0779
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    Fax                  |    505-792-1399
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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       |    NM0150
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    License Number State |    NM
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