Provider Demographics
NPI:1578984431
Name:LEDEZMA, PATRICIA (LBSW)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:LEDEZMA
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 PAINTED PONY LN
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-9308
Mailing Address - Country:US
Mailing Address - Phone:915-526-2967
Mailing Address - Fax:
Practice Address - Street 1:1005 PAINTED PONY LN
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-9308
Practice Address - Country:US
Practice Address - Phone:915-526-2967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMB-070921041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool