Provider Demographics
NPI:1124321534
Name:RAMOTH, EDWARD JR (LMSW)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:RAMOTH
Suffix:JR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93454
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87199-3454
Mailing Address - Country:US
Mailing Address - Phone:505-899-8277
Mailing Address - Fax:
Practice Address - Street 1:311 HERNANDEZ RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1240
Practice Address - Country:US
Practice Address - Phone:505-899-8277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-3130104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker