Provider Demographics
NPI:1124401294
Name:CARRASCO, ROSINA B (LMSW)
Entity type:Individual
Prefix:
First Name:ROSINA
Middle Name:B
Last Name:CARRASCO
Suffix:
Gender:F
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 649
Mailing Address - Street 2:
Mailing Address - City:DONA ANA
Mailing Address - State:NM
Mailing Address - Zip Code:88032-0649
Mailing Address - Country:US
Mailing Address - Phone:575-642-3975
Mailing Address - Fax:
Practice Address - Street 1:3100 OAK ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3769
Practice Address - Country:US
Practice Address - Phone:575-523-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-09053101YP2500X
NM251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional