Provider Demographics
NPI:1063858702
Name:DAVIS-DURAN, REBECCA KATHLEEN (LCSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:KATHLEEN
Last Name:DAVIS-DURAN
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 SAN MATEO BLVD NE APT 1089
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-2609
Mailing Address - Country:US
Mailing Address - Phone:505-234-4554
Mailing Address - Fax:
Practice Address - Street 1:4011 BARBARA LOOP SE STE 208
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1041
Practice Address - Country:US
Practice Address - Phone:505-219-1125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-100021041C0700X
NMC-110101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical