Provider Demographics
NPI:1295802635
Name:RICE, ROBERTA (MSW)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:
Last Name:RICE
Suffix:
Gender:F
Credentials:MSW
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 10509
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87184-0509
Mailing Address - Country:US
Mailing Address - Phone:505-248-0779
Mailing Address - Fax:505-792-1399
Practice Address - Street 1:604 LOS HIJOS NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114
Practice Address - Country:US
Practice Address - Phone:505-248-0779
Practice Address - Fax:505-792-1399
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2008-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM01501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM100495Medicaid
NMNM100495Medicaid