Healthcare Provider Details

I. General information

NPI: 1467774885
Provider Name (Legal Business Name): SCHIA MUTERPERL LMSW, LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 E FAIRVIEW LN
ESPANOLA NM
87532-2822
US

IV. Provider business mailing address

PO BOX 3157
ESPANOLA NM
87533-3157
US

V. Phone/Fax

Practice location:
  • Phone: 505-747-1991
  • Fax:
Mailing address:
  • Phone: 505-747-1991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-1882
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: