Healthcare Provider Details

I. General information

NPI: 1609611789
Provider Name (Legal Business Name): ELENA COLEMAN SPAFFORD MSW, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MEDICAL ARTS AVE NE BLDG 3
ALBUQUERQUE NM
87102-2722
US

IV. Provider business mailing address

4424 AVENIDA MANANA NE
ALBUQUERQUE NM
87110-6169
US

V. Phone/Fax

Practice location:
  • Phone: 505-933-4639
  • Fax:
Mailing address:
  • Phone: 505-250-7976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2024-0445
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: