Provider Demographics
NPI:1376813071
Name:RUBALCABA, DEMIAN HUEMAC (LCSW)
Entity type:Individual
Prefix:
First Name:DEMIAN
Middle Name:HUEMAC
Last Name:RUBALCABA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 GANDERT AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-9607
Mailing Address - Country:US
Mailing Address - Phone:505-610-3610
Mailing Address - Fax:505-248-1351
Practice Address - Street 1:6000 UPTOWN BLVD NE STE 305
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4148
Practice Address - Country:US
Practice Address - Phone:505-219-1125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-090491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical