Provider Demographics
NPI:1174959720
Name:YOUNGBLOOD, ROZELLA SARAH (LCSW)
Entity type:Individual
Prefix:
First Name:ROZELLA
Middle Name:SARAH
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ROZELLA
Other - Middle Name:SARAH
Other - Last Name:ZALESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1201 3RD ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1403
Mailing Address - Country:US
Mailing Address - Phone:505-242-4399
Mailing Address - Fax:
Practice Address - Street 1:1201 3RD ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1403
Practice Address - Country:US
Practice Address - Phone:505-242-4399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-15
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-098361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical