Individual
ROSALVA BLANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2625 MCNUTT RD STE B, SUNLAND PARK, NM 88063-9608
(575) 589-6540
(575) 589-5864
Mailing address
385 CALLE DE ALEGRA STE A, LAS CRUCES, NM 88005-3423
(575) 526-1105
(575) 524-4266
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
M-10979
NM
1041C0700X
Clinical Social Worker
Primary
C-12152
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16255267
—
NM
Enumeration date
05/31/2019
Last updated
05/04/2022
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