MEDICARE: JAMES H. SHOTWELL 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
1	1041C0700X	Clinical Social Worker	I-3892	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	201021113	OTHER	NM	PRESBYTERIAN HEALTH PLAN
2	VNM00212OT	OTHER	NM	VALUEOPTIONS NEW MEXICO
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306944988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES H. SHOTWELL LCSW

Provider Business Mailing Address
First Line	:	5033 WHITE OWL WAY NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-0884
Country	:	US
Telephone Number	:	505-891-1583
Fax Number	:

Provider Business Practice Location Address
First Line	:	4004 CARLISLE BLVD NE STE A2
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-4566
Country	:	US
Telephone Number	:	505-891-1583
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/21/2022

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