Provider Demographics
NPI:1871639385
Name:MONTES DE OCA, LYDIA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:
Last Name:MONTES DE OCA
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 1:2910 DURANGO RD SW
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-0217
Mailing Address - Country:US
Mailing Address - Phone:505-898-9649
Mailing Address - Fax:
Practice Address - Street 1:1101 PARK AVE SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2967
Practice Address - Country:US
Practice Address - Phone:505-764-2000
Practice Address - Fax:505-764-2020
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM062841041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM67225551Medicaid