Provider Demographics
NPI:1316531791
Name:VERDUGO, AVA (LMSW)
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:
Last Name:VERDUGO
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 1:251 N ROADRUNNER PKWY APT 802
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-7012
Mailing Address - Country:US
Mailing Address - Phone:575-921-1099
Mailing Address - Fax:
Practice Address - Street 1:755 S TELSHOR BLVD STE 203T
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8679
Practice Address - Country:US
Practice Address - Phone:575-647-1604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NMSWB-2024-0456104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM171M00000XOther171M00000X