Provider Demographics
NPI:1740338268
Name:NEVAREZ, JUANA (LCSW)
Entity type:Individual
Prefix:
First Name:JUANA
Middle Name:
Last Name:NEVAREZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JUANA
Other - Middle Name:
Other - Last Name:NEVAREZ-JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:461 BLUE SAGE AVE SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-6643
Mailing Address - Country:US
Mailing Address - Phone:505-515-7980
Mailing Address - Fax:
Practice Address - Street 1:461 BLUE SAGE AVE SW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-6643
Practice Address - Country:US
Practice Address - Phone:505-515-7980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2023-06-27
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-08-14
Provider Licenses
StateLicense IDTaxonomies
NMM-05683104100000X
NMM056831041S0200X
NMC-096311041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM58925333Medicaid