Provider Demographics
NPI:1568612638
Name:RODRIGUEZ, LAURA C (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:C
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:C
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:1937 ROBERTSON RD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-4057
Mailing Address - Country:US
Mailing Address - Phone:505-440-1590
Mailing Address - Fax:
Practice Address - Street 1:1937 ROBERTSON RD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-4057
Practice Address - Country:US
Practice Address - Phone:505-440-1590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-073001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical