Healthcare Provider Details

I. General information

NPI: 1336328871
Provider Name (Legal Business Name): RACHAEL ELEBARIO SW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 VALDORA RD SW ERNIE PYLE MS
ALBUQUERQUE NM
87105-4551
US

IV. Provider business mailing address

1820 VALDORA RD SW ERNIE PYLE MS
ALBUQUERQUE NM
87105-4551
US

V. Phone/Fax

Practice location:
  • Phone: 505-877-3770
  • Fax:
Mailing address:
  • Phone: 505-877-3770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-07472
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberI-07472
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: