Healthcare Provider Details

I. General information

NPI: 1083609291
Provider Name (Legal Business Name): G ANN REMICK-BARLOW LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 WESTWIND RD
LAS CRUCES NM
88007-4536
US

IV. Provider business mailing address

2027 WESTWIND RD
LAS CRUCES NM
88007-4536
US

V. Phone/Fax

Practice location:
  • Phone: 505-526-6040
  • Fax: 505-523-8837
Mailing address:
  • Phone: 505-526-6040
  • Fax: 505-523-8837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI2560
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS19588
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: