Provider Demographics
NPI:1043501711
Name:TAVITAS, NATALIE ROCHELLE (LMSW)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:ROCHELLE
Last Name:TAVITAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 LAMBERTON PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1641
Mailing Address - Country:US
Mailing Address - Phone:505-841-7800
Mailing Address - Fax:
Practice Address - Street 1:1031 LAMBERTON PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1641
Practice Address - Country:US
Practice Address - Phone:505-841-7851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2013-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-07465104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker