Provider Demographics
NPI:1811021926
Name:ARMIJO, RICHARD (MA BSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:ARMIJO
Suffix:
Gender:M
Credentials:MA BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 E TILDEN ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-3822
Mailing Address - Country:US
Mailing Address - Phone:505-425-2886
Mailing Address - Fax:505-454-5702
Practice Address - Street 1:901 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-3928
Practice Address - Country:US
Practice Address - Phone:505-454-5700
Practice Address - Fax:505-454-5702
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMB-14741041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1041S0200XMedicaid