Provider Demographics
NPI:1871204248
Name:CARRASCO, DEVONICA (LMSW)
Entity type:Individual
Prefix:
First Name:DEVONICA
Middle Name:
Last Name:CARRASCO
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 1:1609 W LEA ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3752
Mailing Address - Country:US
Mailing Address - Phone:575-706-7990
Mailing Address - Fax:
Practice Address - Street 1:1609 W LEA ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3752
Practice Address - Country:US
Practice Address - Phone:575-706-7990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-118221041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool