Provider Demographics
NPI:1194537415
Name:ROLDAN, LINDA ROSE (LBSW)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ROSE
Last Name:ROLDAN
Suffix:
Gender:F
Credentials:LBSW
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 19000
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88102-9000
Mailing Address - Country:US
Mailing Address - Phone:575-769-4490
Mailing Address - Fax:575-769-4330
Practice Address - Street 1:1009 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-5932
Practice Address - Country:US
Practice Address - Phone:575-769-4490
Practice Address - Fax:575-769-4330
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2024-07081041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool