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NPI Code Detail

MEDICARE: MS. ELIZABETH INEZ FERNANDEZ LCSW

MEDICARE: MS. ELIZABETH INEZ FERNANDEZ LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerC-09090NM

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1468282YRNDOTHERNMMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053628545
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ELIZABETH INEZ FERNANDEZ LCSW
Provider Business Mailing Address
First Line : 385 CALLE DE ALEGRA STE A
Second Line :
City : LAS CRUCES
State : NM
Zip : 88005-3423
Country : US
Telephone Number : 575-526-1105
Fax Number : 575-524-4266
Provider Business Practice Location Address
First Line : 118 S MAIN ST
Second Line :
City : LAS CRUCES
State : NM
Zip : 88001-1266
Country : US
Telephone Number : 575-647-2800
Fax Number : 575-647-2898
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2010
Last Update Date : 08/28/2018

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