MS. BONITA RAE WICKSTROM LISW
NPI 1225075161
Social Worker in Albuquerque, NM

Q: What is Bonita Wickstrom's NPI number?

The NPI number for Bonita Wickstrom is 1225075161. It was assigned to this individual provider in the NPPES registry on May 31, 2006.

Q: What is Bonita Wickstrom's specialty?

The primary specialty registered for this NPI is Social Worker with taxonomy code 104100000X.

Q: Is Bonita Wickstrom enrolled in Medicare?

No. Bonita Wickstrom has opted out of Medicare through July 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

Q: When was this NPI record last updated?

The NPPES record for Bonita Wickstrom was last updated on July 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 31, 2006Opted out of Medicare · through Jul 1, 2028

12836 LOMAS BLVD NE, SUITE B, ALBUQUERQUE, NM 87112(505) 453-7862 Get Directions Write a Review

NPPES record last updated: July 13, 2026. Verified against the NPPES registry weekly; last sync: September 13, 2026.

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About Ms. Bonita Rae Wickstrom Lisw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. BONITA RAE WICKSTROM LISW (NPI 1225075161) is an individual social worker in Albuquerque, New Mexico, licensed in New Mexico (I-4390) and active in the NPI registry since May 2006. She has opted out of Medicare through July 1, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1225075161

Entity TypeIndividualFemale

Primary Taxonomy104100000X

Provider Legal NameMS. BONITA RAE WICKSTROMCredential: LISW

Location Address12836 LOMAS BLVD NE, SUITE BAlbuquerque, NM 87112-6210

Mailing Address14507 Encantado Rd NeAlbuquerque, NM 87123-2249 · (505) 275-7795

Phone(505) 453-7862

Sole ProprietorNo

Enumeration DateMay 31, 2006

Last NPPES UpdateJuly 13, 2026

✔ NPI 1225075161 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial WorkerBehavioral Health & Social Service Providers

Taxonomy Code104100000X

License✔ Licensed in NM · I-4390

Definition

A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public.

12836 LOMAS BLVD NE, Albuquerque, NM 87112

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Ms. Bonita Rae Wickstrom Lisw has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from July 1, 2016 through July 1, 2028.

Opt-Out Effective DateJuly 1, 2016

Opt-Out In Effect ThroughJuly 1, 2028Opt-out affidavits renew automatically every two years unless cancelled

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. ELLEN M. CURLEY-ROAM LISW

Social Worker (Clinical)

12836 LOMAS BLVD NE, SUITE B
ALBUQUERQUE, NM 87112

Bernalillo County (505) 306-6047

MS. LUCY A BIRBIGLIA LCSW LISW

Social Worker (Clinical)

12836 LOMAS BLVD NE, SUITE B
ALBUQUERQUE, NM 87112

Bernalillo County (505) 307-3718

BONITA WICKSTROM INC

Social Worker (Clinical)

12836 LOMAS BLVD NE, SUITE B
ALBUQUERQUE, NM 87112

Bernalillo County (505) 453-7862

DR. BHALACHANDRA A KULKARNI MD

Family Medicine

12836 LOMAS BLVD NE, SUITE D
ALBUQUERQUE, NM 87112

Bernalillo County (505) 298-0230

MS. LYNETTE A CURLEY-ROAM LISW, REV.

Social Worker (Clinical)

12836 LOMAS BLVD NE, STE. B
ALBUQUERQUE, NM 87112

Bernalillo County (505) 306-6272

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Bonita Wickstrom's NPI number?

The NPI number for Bonita Wickstrom is 1225075161. It was assigned to this individual provider in the NPPES registry on May 31, 2006.

Where is Bonita Wickstrom located?

Bonita Wickstrom practices at 12836 Lomas Blvd NE Suite B, Albuquerque, NM 87112. The listed phone number is (505) 453-7862.

What is Bonita Wickstrom's specialty?

The primary specialty registered for this NPI is Social Worker with taxonomy code 104100000X.

Is Bonita Wickstrom enrolled in Medicare?

No. Bonita Wickstrom has opted out of Medicare through July 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Bonita Wickstrom was last updated on July 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.