Provider Demographics
NPI:1417134875
Name:NAVARRETE, VERONICA (LCSW)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:NAVARRETE
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 1:500 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3440
Mailing Address - Country:US
Mailing Address - Phone:575-621-9685
Mailing Address - Fax:
Practice Address - Street 1:500 N CHURCH ST STE 209
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3440
Practice Address - Country:US
Practice Address - Phone:575-621-9685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-058971041S0200X
NMC-070751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM36203262Medicaid