Healthcare Provider Details

I. General information

NPI: 1659944080
Provider Name (Legal Business Name): STEPHEN JEROME CHAVEZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 PEDRO CHAVEZ LN NE
LOS LUNAS NM
87031-6522
US

IV. Provider business mailing address

560 PEDRO CHAVEZ LN NE
LOS LUNAS NM
87031-6522
US

V. Phone/Fax

Practice location:
  • Phone: 505-309-0775
  • Fax:
Mailing address:
  • Phone: 505-309-0775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2024-1239
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: