Provider Demographics
NPI:1477937027
Name:TRUJILLO, JULIAN ROBERT III (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JULIAN
Middle Name:ROBERT
Last Name:TRUJILLO
Suffix:III
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 3RD ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:912 1ST ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2355
Practice Address - Country:US
Practice Address - Phone:505-224-9777
Practice Address - Fax:505-224-9779
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2024-03-01
Deactivation Date:2021-07-26
Deactivation Code:
Reactivation Date:2021-08-11
Provider Licenses
StateLicense IDTaxonomies
NM3130171M00000X
NMSWB-2023-12251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1902918055Medicaid