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General NPI Number Information
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NPI Number | 1518752534
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Entity Type | Organization
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Legal Business Name | BOLDLY RESILIENT LLC
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Dates
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Enumeration Date | 04/10/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 6713 4TH ST NW
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City | LOS RANCHOS
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State | NM
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Zip | 87107-6114
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Country | US
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Telephone | 505-718-2119
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Fax |
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Provider Business Mailing Address
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Address Line | 6411 CANAVIO PL NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-7052
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Country | US
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Telephone | 505-718-2119
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MRS. DOLORES RUIZ-CHAVEZ
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Credential | LCSW
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Telephone | 505-718-2119
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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 |
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License Number State |
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