Healthcare Provider Details

I. General information

NPI: 1467994418
Provider Name (Legal Business Name): JOSE ALBERTO FAIT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 W BROADWAY ST
HOBBS NM
88240-5529
US

IV. Provider business mailing address

PO BOX 907
HOBBS NM
88241-0907
US

V. Phone/Fax

Practice location:
  • Phone: 575-393-3168
  • Fax:
Mailing address:
  • Phone: 575-393-3168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW90193
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2026-0940
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW74385
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: