Provider Demographics
NPI:1316631054
Name:RODRIGUEZ, LUISA ANTONIA (LMSW, LSSW)
Entity type:Individual
Prefix:
First Name:LUISA
Middle Name:ANTONIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LMSW, LSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-6415
Mailing Address - Country:US
Mailing Address - Phone:575-973-7193
Mailing Address - Fax:
Practice Address - Street 1:2810 SUDDERTH DR STE 210
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6307
Practice Address - Country:US
Practice Address - Phone:575-973-7193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-09516104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker