Individual
ANDREA MARIE BACA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPSW
Contact information
Practice address
13139 CENTRAL AVE NE, ALBUQUERQUE, NM 87123-3031
(505) 575-1607
Mailing address
13139 CENTRAL AVE NE, ALBUQUERQUE, NM 87123-3031
(505) 575-1607
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
172V00000X
Community Health Worker
—
NM
175T00000X
Peer Specialist
Primary
—
NM
Other
Enumeration date
08/29/2019
Last updated
02/04/2026
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