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MRS. NETTIE LYNNE ROSE LISW LADAC
NPI 1407847403
Counselor - Addiction (Substance Use Disorder) in Albuquerque, NM

Active since October 31, 2005PECOS EnrolledAccepts Medicare Assignment
1610 SAN PEDRO NE #A, ALBUQUERQUE, NM 87110(505) 265-0753(505) 268-5722 Get Directions Write a Review

NPPES record last updated: September 9, 2020. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Mrs. Nettie Lynne Rose Lisw Ladac NPPES

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

MRS. NETTIE LYNNE ROSE LISW LADAC (NPI 1407847403) is an individual addiction (substance use disorder) provider in Albuquerque, New Mexico, licensed in New Mexico (C-4453) and active in the NPI registry since October 2005. She is enrolled in Medicare PECOS and is a graduate of Other (1996).

NPPES Registry Identity

NPI1407847403
Entity TypeIndividualFemale
Primary Taxonomy101YA0400X
Provider Legal NameMRS. NETTIE LYNNE ROSECredential: LISW LADAC
Location Address1610 SAN PEDRO NE #AAlbuquerque, NM 87110
Mailing Address1610 San Pedro Ne #aAlbuquerque, NM 87110 · (225) 936-7242
Phone(505) 265-0753
Fax(505) 268-5722
Sole ProprietorYes
Medical School CMSOtherGraduated 1996
Enumeration DateOctober 31, 2005
Last NPPES UpdateSeptember 9, 2020
NPPES CertifiedSeptember 9, 2020
✔ NPI 1407847403 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
Licenses✔ Licensed in NM · C-4453✔ Licensed in NM · 4198
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X · License I4453 (NM)

Other Names 1

Former Name (1)Ms. Nettie Lynne Clegg

Other Identifiers 1

Medicaid37376764NM

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mrs. Nettie Lynne Rose Lisw Ladac is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8325575673
PECOS Enrollment IDI20250911002139
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Nettie Rose reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Dragonfly Counseling Associates Inc.
Community/Behavioral Health
1110 PENNSYLVANIA ST NE, SUITE B
Albuquerque, NM 87110
  • Reassigned Medicare billing, New Mexico enrollment
NPI 1033230818 (505) 265-0753

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES

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

MS. CHRISTINA R CANDELARIA LICENSED CLINICAL SO
Social Worker (School)
1610 SAN PEDRO NE #A, #A
ALBUQUERQUE, NM 87110
Bernalillo County (505) 265-0753

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 Nettie Rose's NPI number?

The NPI number for Nettie Rose is 1407847403. It was assigned to this individual provider in the NPPES registry on October 31, 2005. The provider is also known as Ms. Nettie Lynne Clegg.

Where is Nettie Rose located?

Nettie Rose practices at 1610 San Pedro NE #a, Albuquerque, NM 87110. The listed phone number is (505) 265-0753.

What is Nettie Rose's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

Is Nettie Rose enrolled in Medicare?

Yes. Nettie Rose is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Nettie Rose's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Nettie Rose reassigns Medicare benefits to Dragonfly Counseling Associates Inc. (Albuquerque, NM). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Nettie Rose's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Nettie Rose was last updated on September 9, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years 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.