Tony Bobadilla, LCSW, PHD

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C-09780 Issued in NM

Practice address

505 S Main St
Ste 249
Las Cruces, NM 88001-1206

Phone

(575) 527-5884

Fax

(575) 527-5886

NPI assigned

Aug 10, 2013

Sex

Male

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Nueva Vida Behavioral Health Associates,Inc

  • Professional Counselor
  • San Antonio, TX
  • NPI 1669565529

  TX

  Medicare reassignment NPD
• Aprendamos Intervention Team PA

  • Speech-Language Pathologist
  • Las Cruces, NM
  • NPI 1891245189

  Clinical

  NPD (past)

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 21, 2022.

{
    "created_epoch": "1376092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1710310016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 S MAIN ST",
            "address_2": "STE 249",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880011206",
            "telephone_number": "575-527-5884",
            "fax_number": "575-527-5886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 S MAIN ST",
            "address_2": "STE 249",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880011206",
            "telephone_number": "575-527-5884",
            "fax_number": "575-527-5886"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1681 Hickory Loop",
            "address_purpose": "LOCATION",
            "city": "Las Cruces",
            "state": "NM",
            "postal_code": "880056502",
            "country_code": "US",
            "telephone_number": "575-647-3773",
            "fax_number": "575-647-3777",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1271 Anthony Drive",
            "address_purpose": "LOCATION",
            "city": "Anthony",
            "state": "NM",
            "postal_code": "88021",
            "country_code": "US",
            "telephone_number": "575-882-3401",
            "fax_number": "575-882-3256",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOBADILLA",
        "first_name": "TONY",
        "credential": "LCSW, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-08-10",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NM",
            "license": "M-08350",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NM",
            "license": "C-09780",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NM REG & LICENSING DEPT",
            "identifier": "C-09780",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carol Sue Blum, PHD
• Maria Blum, RN
• Stephanie Katharina Blumenschein-Wing, RN
• Board of Commissioners City of Las Cruces
• Jarajia Boatman
• Anthony Michael Bocchicchio, PSYD
• Ann Boden, LPCC
• Jennifer Bodisch
• Body Bella
• Judith Anne Boehmer, LPCC

• All providers in Las Cruces, NM
• Clinical Social Worker in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.