Provider Demographics
NPI:1215029574
Name:APODACA, EDMUNDO E (LISW)
Entity Type:Individual
Prefix:
First Name:EDMUNDO
Middle Name:E
Last Name:APODACA
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 10TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-4135
Mailing Address - Country:US
Mailing Address - Phone:505-385-7947
Mailing Address - Fax:
Practice Address - Street 1:504 10TH AVE NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-4135
Practice Address - Country:US
Practice Address - Phone:505-385-7947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-059311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical