Provider Demographics
NPI:1043501711
Name:TAVITAS, NATALIE ROCHELLE (LCSW)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:ROCHELLE
Last Name:TAVITAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CANYON LN
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREST
Mailing Address - State:NM
Mailing Address - Zip Code:87008-9458
Mailing Address - Country:US
Mailing Address - Phone:505-575-0704
Mailing Address - Fax:
Practice Address - Street 1:15 CANYON LN
Practice Address - Street 2:
Practice Address - City:CEDAR CREST
Practice Address - State:NM
Practice Address - Zip Code:87008-9458
Practice Address - Country:US
Practice Address - Phone:505-575-0704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-096021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty