Provider Demographics
NPI:1144553066
Name:MARQUEZ, NEVIN RAY (BA)
Entity type:Individual
Prefix:MR
First Name:NEVIN
Middle Name:RAY
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 CARLISLE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1644
Mailing Address - Country:US
Mailing Address - Phone:505-366-7538
Mailing Address - Fax:
Practice Address - Street 1:12013RD ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87125
Practice Address - Country:US
Practice Address - Phone:505-764-8231
Practice Address - Fax:505-248-1351
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NMSWV-2023-06531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor