Healthcare Provider Details

I. General information

NPI: 1134461734
Provider Name (Legal Business Name): ROY EDWARD HARRINGTON LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 E CHUSKA ST
AZTEC NM
87410-2113
US

IV. Provider business mailing address

2900 MUNICIPAL DR
FARMINGTON NM
87401-3984
US

V. Phone/Fax

Practice location:
  • Phone: 505-333-7042
  • Fax: 505-333-7043
Mailing address:
  • Phone: 505-860-5038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-08016
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: