Provider Demographics
NPI:1417604851
Name:RODRIGUEZ, MONIQUE NUNCIO (LCSW, LSAA)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:NUNCIO
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LCSW, LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 E LOHMAN #110
Mailing Address - Street 2:PMB 163
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3197
Mailing Address - Country:US
Mailing Address - Phone:832-275-9710
Mailing Address - Fax:
Practice Address - Street 1:530 N CHURCH ST
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:575-526-9878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-06
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCSA0222541101YA0400X
TX627191041C0700X
NMSWB-2023-12851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)