Provider Demographics
NPI:1376790931
Name:RICE, MICHELLE RIOS (MSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RIOS
Last Name:RICE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 CALLE DERECHA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6530
Mailing Address - Country:US
Mailing Address - Phone:505-471-0038
Mailing Address - Fax:
Practice Address - Street 1:2916 CALLE DERECHA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6530
Practice Address - Country:US
Practice Address - Phone:505-471-0038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX06366174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist