Provider Demographics
NPI:1649605015
Name:RASCON-THORPE, ANDREA LYNETTE (LCSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNETTE
Last Name:RASCON-THORPE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4308 CARLISLE BLVD NE, STE 210
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4849
Mailing Address - Country:US
Mailing Address - Phone:505-269-7356
Mailing Address - Fax:505-247-1020
Practice Address - Street 1:4308 CARLISLE BLVD NE, STE 210
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4849
Practice Address - Country:US
Practice Address - Phone:505-269-7356
Practice Address - Fax:505-247-1020
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-086581041C0700X
NMX-083511041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM42678340Medicaid
NMX-08351OtherSTATE OF NEW MEXICO