Healthcare Provider Details

I. General information

NPI: 1679277958
Provider Name (Legal Business Name): JAMES SANTAGUIDA LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8117 HANNETT AVE NE
ALBUQUERQUE NM
87110-6013
US

IV. Provider business mailing address

8117 HANNETT AVE NE
ALBUQUERQUE NM
87110-6013
US

V. Phone/Fax

Practice location:
  • Phone: 505-259-7573
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2022-0869
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: