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General NPI Number Information
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NPI Number | 1316631054
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Entity Type | Individual
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Provider Name | LUISA ANTONIA RODRIGUEZ LMSW, LSSW
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Gender | Female
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Dates
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Enumeration Date | 06/06/2023
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Last Update Date | 06/06/2023
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Provider Practice Location Address
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Address Line | 2810 SUDDERTH DR STE 210
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City | RUIDOSO
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State | NM
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Zip | 88345-6307
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Country | US
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Telephone | 575-973-7193
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Fax |
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Provider Business Mailing Address
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Address Line | 124 MAPLE DR
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City | RUIDOSO
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State | NM
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Zip | 88345-6415
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Country | US
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Telephone | 575-973-7193
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | M-09516
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License Number State | NM
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