Healthcare Provider Details

I. General information

NPI: 1356933048
Provider Name (Legal Business Name): AUTUMN ARAGON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PAISANO ST NE
ALBUQUERQUE NM
87123-1453
US

IV. Provider business mailing address

239 ELM ST NE
ALBUQUERQUE NM
87102-3672
US

V. Phone/Fax

Practice location:
  • Phone: 505-948-0288
  • Fax:
Mailing address:
  • Phone: 505-720-0590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCSA0214241
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2023-1315
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: