Individual
NICHOLAS BOEDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1335 GUSDORF ROAD, BUILDING E, TAOS, NM 87571
(575) 758-0670
Mailing address
PO BOX 437, EL PRADO, NM 87529
(575) 770-0436
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C-08893
NM
Other
Enumeration date
04/01/2015
Last updated
12/15/2016
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