Provider Demographics
NPI:1639650153
Name:LOZUAWAY, RHIANNON (LCSW)
Entity type:Individual
Prefix:
First Name:RHIANNON
Middle Name:
Last Name:LOZUAWAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RHIANNON
Other - Middle Name:
Other - Last Name:DUKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2055 S PACHECO ST STE 500
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3994
Mailing Address - Country:US
Mailing Address - Phone:505-702-8112
Mailing Address - Fax:
Practice Address - Street 1:2055 S PACHECO ST STE 500
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3994
Practice Address - Country:US
Practice Address - Phone:505-702-8112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH104100000X
NMSWB-2024-05101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3078870Medicaid
NM28189060Medicaid