MEDICARE: NEW ROOTS COUNSELING LLC

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

General Provider Information

NPI Number	:	1619513322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW ROOTS COUNSELING LLC

Provider Business Mailing Address
First Line	:	PO BOX 27523
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87125-7523
Country	:	US
Telephone Number	:	505-553-5281
Fax Number	:

Provider Business Practice Location Address
First Line	:	1127 WALDIE RD SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-3782
Country	:	US
Telephone Number	:	505-553-5281
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHERRI S FRANCIS
Credential	:	LCSW
Telephone Number	:	505-553-5281

Provider Enumeration Date	:	11/18/2019
Last Update Date	:	01/08/2020

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