Healthcare Provider Details

I. General information

NPI: 1174262901
Provider Name (Legal Business Name): NATALIE THERESA CHAVEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3736 EUBANK BLVD NE STE B1
ALBUQUERQUE NM
87111-3583
US

IV. Provider business mailing address

9531 VALLETTA AVE NW
ALBUQUERQUE NM
87120-2997
US

V. Phone/Fax

Practice location:
  • Phone: 505-382-1578
  • Fax: 888-506-2110
Mailing address:
  • Phone: 505-489-2075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-10508
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: