Most Relevant Information
Provider Data
| NPI Number: | 1003587551 |
| Provider Name: | KYLE ROUCKUS LCSW |
| Entity Type: | Individual |
| Taxonomy Code: | 104100000X |
| Specialty: | Social Worker |
| License Number: | SWB-2023-1127 |
Most Important Dates
| Enumeration Date: | 09/24/2021 |
| Last Updated: | 01/16/2024 |
Provider Practice Location
528 CARLISLE BLVD NE
ALBUQUERQUE
NM
871061323
Practice Location Phone/Fax
| Phone: | 5053633313 |
| Fax: |
Provider Mailing Location
528 CARLISLE BLVD NE
ALBUQUERQUE
NM
871061323
Provider Mailing Phone/Fax
| Phone: | 5053633313 |
| Fax: |