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Individual

MR. RICHARD BRANNEN LARA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LMSW

Contact information

Practice address
404 HUNTER ST, ESPANOLA, NM 87532-2655
(505) 753-4123
(505) 753-6947
Mailing address
404 HUNTER ST, ESPANOLA, NM 87532-2655
(505) 753-4123
(505) 753-6947

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
X05752
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
E7436
NM
Enumeration date
03/01/2007
Last updated
01/06/2012
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