Provider Demographics
NPI:1568551661
Name:APODACA, ANNE ROBERTA (LMSW)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:ROBERTA
Last Name:APODACA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 RIO GRANDE BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-2976
Mailing Address - Country:US
Mailing Address - Phone:505-328-3300
Mailing Address - Fax:505-345-0277
Practice Address - Street 1:227 HIGH ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3624
Practice Address - Country:US
Practice Address - Phone:505-328-3300
Practice Address - Fax:505-345-0277
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-05682104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM12735OtherLOVELACE HEALTH PLAN