Individual
NICOLE K DEHERRERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
4601 COLLEGE BLVD, FARMINGTON, NM 87402-4609
(505) 566-3846
(505) 566-3687
Mailing address
4601 COLLEGE BLVD, FARMINGTON, NM 87402-4609
(505) 566-3846
(505) 566-3687
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
M-07674
NM
1041C0700X
Clinical Social Worker
Primary
I-08612
NM
Other
Enumeration date
09/29/2009
Last updated
03/18/2014
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