Provider Demographics
NPI:1215380696
Name:COVEY, BERTA ALICIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BERTA
Middle Name:ALICIA
Last Name:COVEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 CARLYLE DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-1635
Mailing Address - Country:US
Mailing Address - Phone:575-312-2514
Mailing Address - Fax:
Practice Address - Street 1:1955 CARLYLE DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-1635
Practice Address - Country:US
Practice Address - Phone:575-312-2514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-25171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical