Healthcare Provider Details

I. General information

NPI: 1508134511
Provider Name (Legal Business Name): MONICA MARIE CHAVEZ P.M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 CENTRAL AVE NW
ALBUQUERQUE NM
87105-2036
US

IV. Provider business mailing address

6301 CENTRAL N.W.
ALBUQUERQUE NM
87105-2036
US

V. Phone/Fax

Practice location:
  • Phone: 505-831-6038
  • Fax:
Mailing address:
  • Phone: 505-831-6038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberX-07303
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: