Healthcare Provider Details

I. General information

NPI: 1386899094
Provider Name (Legal Business Name): DEBORAH JOYCE ARRAJ LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 11/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 571 BLDG #28
EL RITO NM
87530-0237
US

IV. Provider business mailing address

#35282 HWY 285
OJO CALIENTE NM
87549-0307
US

V. Phone/Fax

Practice location:
  • Phone: 575-581-4728
  • Fax: 575-581-0030
Mailing address:
  • Phone: 575-583-2191
  • Fax: 575-581-0030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberI-06703
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: