Provider Demographics
NPI:1790238343
Name:ROLDAN, MARIA DE JESUS (LCSW)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DE JESUS
Last Name:ROLDAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:DE JESUS
Other - Last Name:MERAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:838 W DIDIER AVE
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-3160
Mailing Address - Country:US
Mailing Address - Phone:505-312-0040
Mailing Address - Fax:
Practice Address - Street 1:838 W DIDIER AVE
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-3160
Practice Address - Country:US
Practice Address - Phone:505-312-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2022-10331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10124314Medicaid