Healthcare Provider Details

I. General information

NPI: 1689879710
Provider Name (Legal Business Name): CHRISTOPHER W MASON LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 S SOLANO DR
LAS CRUCES NM
88001-3758
US

IV. Provider business mailing address

713 STAGECOACH DR
LAS CRUCES NM
88011-8013
US

V. Phone/Fax

Practice location:
  • Phone: 505-373-4489
  • Fax:
Mailing address:
  • Phone: 505-640-6214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-07132
License Number StateNM

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: