MEDICARE: REBECCA KATHLEEN DAVIS-DURAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	M-10002	NM
2	1041C0700X	Clinical Social Worker	C-11010	NM

General Provider Information

NPI Number	:	1063858702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA KATHLEEN DAVIS-DURAN LCSW

Provider Business Mailing Address
First Line	:	9100 SAN MATEO BLVD NE APT 1089
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-2609
Country	:	US
Telephone Number	:	505-234-4554
Fax Number	:

Provider Business Practice Location Address
First Line	:	4011 BARBARA LOOP SE STE 208
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-1041
Country	:	US
Telephone Number	:	505-219-1125
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2013
Last Update Date	:	04/29/2025

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