MEDICARE: LAURA ROSE KING 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	SWB-2022-0534	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SWB20220534	OTHER	NM	LCSW
2	M-11786	OTHER	NM	LMSW

General Provider Information

NPI Number	:	1942872999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ROSE KING LCSW

Provider Business Mailing Address
First Line	:	PO BOX 102
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88202-0102
Country	:	US
Telephone Number	:	573-413-7882
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 S LEA AVE # 4
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88203-4562
Country	:	US
Telephone Number	:	575-347-1883
Fax Number	:	737-201-2725

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

Provider Enumeration Date	:	07/10/2021
Last Update Date	:	03/04/2026

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Directions to “ LAURA ROSE KING LCSW” Practice Location

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