Provider Demographics
NPI:1255097044
Name:REID, RONALD D'MON (LMSW)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:D'MON
Last Name:REID
Suffix:
Gender:M
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:PO BOX 19000
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88102-9000
Mailing Address - Country:US
Mailing Address - Phone:575-769-4490
Mailing Address - Fax:575-769-4430
Practice Address - Street 1:1600 SUTTER PL
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4611
Practice Address - Country:US
Practice Address - Phone:575-769-4490
Practice Address - Fax:575-769-4430
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2024-00451041C0700X
NMM-11141104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker