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General NPI Number Information
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NPI Number | 1437464138
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Entity Type | Individual
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Provider Name | PAULA L RALEY LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/18/2010
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Last Update Date | 09/11/2015
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Provider Practice Location Address
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Address Line | 2112 MAIN STREET NE SUITE A
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City | LOS LUNAS
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State | NM
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Zip | 87031
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Country | US
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Telephone | 505-916-5900
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Fax | 505-916-5901
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Provider Business Mailing Address
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Address Line | 2441 CABEZON BLVD SE
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City | RIO RANCHO
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State | NM
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Zip | 87124
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Country | US
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Telephone | 505-717-1155
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Fax | 505-717-1473
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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 | M07384
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | NM
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