Provider Demographics
NPI:1699784462
Name:OBREGON, ROSALIE DELFINA (LISW)
Entity type:Individual
Prefix:MS
First Name:ROSALIE
Middle Name:DELFINA
Last Name:OBREGON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4926
Mailing Address - Country:US
Mailing Address - Phone:505-425-6788
Mailing Address - Fax:505-425-5408
Practice Address - Street 1:1235 8TH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4219
Practice Address - Country:US
Practice Address - Phone:505-425-6788
Practice Address - Fax:505-425-5408
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI047891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical