Provider Demographics
NPI:1215439260
Name:LABATAD, ROQUEL (LCSW)
Entity type:Individual
Prefix:
First Name:ROQUEL
Middle Name:
Last Name:LABATAD
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 1:2801 MOUNTAIN RD NW APT 1
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104-1754
Mailing Address - Country:US
Mailing Address - Phone:505-203-5414
Mailing Address - Fax:
Practice Address - Street 1:2221 RIO GRANDE BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-2529
Practice Address - Country:US
Practice Address - Phone:505-203-5414
Practice Address - Fax:505-273-7770
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-10344104100000X
NMC-116021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker