Provider Demographics
NPI:1649301375
Name:TRUJILLO, PAULA M (LMSW)
Entity type:Individual
Prefix:MISS
First Name:PAULA
Middle Name:M
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4310
Mailing Address - Country:US
Mailing Address - Phone:505-891-5335
Mailing Address - Fax:505-891-1180
Practice Address - Street 1:1600 40TH ST NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-7708
Practice Address - Country:US
Practice Address - Phone:505-891-5335
Practice Address - Fax:505-891-1180
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-4336104100000X, 1041S0200X
NMC-064821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool