Krystal Marylou Cdebaca, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

M-11253 Issued in NM

Practice address

2528 Ridge Runner Rd
Las Vegas, NM 87701-4971

Phone

(505) 425-2622

NPI assigned

Sep 2, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Kids Counseling, Inc

  • Clinical Social Worker
  • Mora, NM
  • NPI 1750715645
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599004800000",
    "number": "1811501323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "767 DON GALLEGOS CIR",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877018927",
            "telephone_number": "505-426-6117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2528 RIDGE RUNNER RD",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877014971",
            "telephone_number": "505-425-2622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CDEBACA",
        "first_name": "KRYSTAL",
        "middle_name": "MARYLOU",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-02",
        "last_updated": "2020-09-02",
        "certification_date": "2020-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NM",
            "license": "M-11253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melanie Casias
• Rudy R Castellano, LPC
• Lorena A Castro-Garcia, LMSW
• Mary Ray Cate, M.D.
• Isabel Cavazos, LMSW
• Amaya Chalker, FNP
• Korazon Chavarria, MD
• Andrellita B Chavez, ATC
• Carla Diana Chavez
• Hailey Chavez

• Social Worker in Las Vegas, NM
• Providers in Las Vegas, NM by specialty
• Social Worker in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.