Provider Demographics
NPI:1386849610
Name:MARTINEZ-ARCHULETA, LEANN R (LCSW)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:R
Last Name:MARTINEZ-ARCHULETA
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:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:EL RITO
Mailing Address - State:NM
Mailing Address - Zip Code:87530-0365
Mailing Address - Country:US
Mailing Address - Phone:505-927-1564
Mailing Address - Fax:
Practice Address - Street 1:STATE ROAD 110 HOUSE 35 B
Practice Address - Street 2:
Practice Address - City:EL RITO
Practice Address - State:NM
Practice Address - Zip Code:87530-8753
Practice Address - Country:US
Practice Address - Phone:505-927-1564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC071491041C0700X
NMX-05841101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical