Provider Demographics
NPI:1396129466
Name:SOTO-ENDICOTT, FLORA NATALIA (LCSW)
Entity type:Individual
Prefix:
First Name:FLORA
Middle Name:NATALIA
Last Name:SOTO-ENDICOTT
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 1:2825 CANDELARIA RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-2914
Mailing Address - Country:US
Mailing Address - Phone:505-550-8626
Mailing Address - Fax:510-535-4167
Practice Address - Street 1:2825 CANDELARIA RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-2914
Practice Address - Country:US
Practice Address - Phone:505-550-8626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA914361041C0700X
104100000X
NM118281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker