Healthcare Provider Details

I. General information

NPI: 1982200168
Provider Name (Legal Business Name): ARTURO CARRILLO JR. LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 12/11/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ALAMOSA CTR-6900 GONZALES RD SW
ALBUQUERQUE NM
87121-2401
US

IV. Provider business mailing address

2001 N. CENTRO FAMILIAR BLVD SW
ALBUQUERQUE NM
87105
US

V. Phone/Fax

Practice location:
  • Phone: 505-831-2534
  • Fax: 505-831-4123
Mailing address:
  • Phone: 505-873-7400
  • Fax: 505-241-5188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberX-11745
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: