Individual
IVAN MARIE ROQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1318 7TH ST NW, ALBUQUERQUE, NM 87102-1244
(505) 435-0074
Mailing address
1318 7TH ST NW, ALBUQUERQUE, NM 87102-1244
(505) 435-0074
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C-09696
NM
Other
Enumeration date
09/30/2008
Last updated
04/24/2025
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