Individual
KYLE ROUCKUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
528 CARLISLE BLVD NE, ALBUQUERQUE, NM 87106-1323
(505) 363-3313
Mailing address
528 CARLISLE BLVD NE, ALBUQUERQUE, NM 87106-1323
(505) 363-3313
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SWB-2023-1127
NM
Other
Enumeration date
09/24/2021
Last updated
01/16/2024
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