Provider Demographics
NPI:1720300288
Name:ALLRED, ROBERTA A (LCSW)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:A
Last Name:ALLRED
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:
Other - Last Name:BOYDSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 28220
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87592-8220
Mailing Address - Country:US
Mailing Address - Phone:505-471-5006
Mailing Address - Fax:505-820-9220
Practice Address - Street 1:121 TOWNSGATE PLZ
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-3714
Practice Address - Country:US
Practice Address - Phone:575-742-2620
Practice Address - Fax:575-752-3182
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC074291041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool