Provider Demographics
NPI:1861994774
Name:GUZMAN VEGA, RAQUEL TEREZA (LCSW)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:TEREZA
Last Name:GUZMAN VEGA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15248
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87174-0248
Mailing Address - Country:US
Mailing Address - Phone:505-339-6938
Mailing Address - Fax:
Practice Address - Street 1:1005 21ST ST SE STE B
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4030
Practice Address - Country:US
Practice Address - Phone:505-353-2061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2025-06-13
Deactivation Date:2018-10-28
Deactivation Code:
Reactivation Date:2021-08-25
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2022-0803101YM0800X
NMSWB-2024-11481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty