Individual
KRYSTAL MARYLOU CDEBACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
2528 RIDGE RUNNER RD, LAS VEGAS, NM 87701-4971
(505) 425-2622
Mailing address
767 DON GALLEGOS CIR, LAS VEGAS, NM 87701-8927
(505) 426-6117
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
M-11253
NM
Other
Enumeration date
09/02/2020
Last updated
09/02/2020
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