Provider Demographics
NPI:1518752534
Name:BOLDLY RESILIENT LLC
Entity type:Organization
Organization Name:BOLDLY RESILIENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ-CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-718-2119
Mailing Address - Street 1:6411 CANAVIO PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-7052
Mailing Address - Country:US
Mailing Address - Phone:505-718-2119
Mailing Address - Fax:
Practice Address - Street 1:6411 CANAVIO PL NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-7052
Practice Address - Country:US
Practice Address - Phone:505-718-2119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty