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NPI Code Detail

MEDICARE: RAVEN MONDRAGON LMSW

MEDICARE: RAVEN MONDRAGON LMSW
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
1104100000XSocial WorkerSWB-2024-1201NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1609681774
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAVEN MONDRAGON LMSW
Provider Business Mailing Address
First Line : 385 CALLE DE ALEGRA BLDG A
Second Line :
City : LAS CRUCES
State : NM
Zip : 88005-3423
Country : US
Telephone Number : 575-526-1105
Fax Number : 575-524-4266
Provider Business Practice Location Address
First Line : 535 S MIRANDA ST
Second Line :
City : LAS CRUCES
State : NM
Zip : 88005-2823
Country : US
Telephone Number : 575-647-2800
Fax Number : 575-647-2898
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2025
Last Update Date : 02/03/2026

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Directions to “ RAVEN MONDRAGON LMSW” Practice Location

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