Healthcare Provider Details

I. General information

NPI: 1306944988
Provider Name (Legal Business Name): JAMES H. SHOTWELL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 CARLISLE BLVD NE STE A2
ALBUQUERQUE NM
87107-4566
US

IV. Provider business mailing address

5033 WHITE OWL WAY NE
RIO RANCHO NM
87144-0884
US

V. Phone/Fax

Practice location:
  • Phone: 505-891-1583
  • Fax:
Mailing address:
  • Phone: 505-891-1583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-3892
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: