Healthcare Provider Details

I. General information

NPI: 1417813973
Provider Name (Legal Business Name): CAROYL SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4304 CARLISLE BLVD NE
ALBUQUERQUE NM
87107-4811
US

IV. Provider business mailing address

4304 CARLISLE BLVD NE
ALBUQUERQUE NM
87107-4811
US

V. Phone/Fax

Practice location:
  • Phone: 505-433-7561
  • Fax:
Mailing address:
  • Phone: 505-503-0966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: