Provider Demographics
NPI:1699983874
Name:LAQUERRE, MARIA (MA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:LAQUERRE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4430
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:NM
Mailing Address - Zip Code:88021-4430
Mailing Address - Country:US
Mailing Address - Phone:575-882-5101
Mailing Address - Fax:575-882-2858
Practice Address - Street 1:715 E IDAHO AVE STE 2B
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-4701
Practice Address - Country:US
Practice Address - Phone:575-556-9585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NM0116281106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30931444Medicaid
NH30931444Medicaid