Healthcare Provider Details

I. General information

NPI: 1750020293
Provider Name (Legal Business Name): JULIE CHANIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8021 BEVERLY HILLS AVE NE
ALBUQUERQUE NM
87122-3607
US

IV. Provider business mailing address

8021 BEVERLY HILLS AVE NE
ALBUQUERQUE NM
87122-3607
US

V. Phone/Fax

Practice location:
  • Phone: 505-730-8243
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberM-06683
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: