Healthcare Provider Details

I. General information

NPI: 1639789209
Provider Name (Legal Business Name): AMANDA BURAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA BRINEGAR LICSW

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 CALLE DE SANTIAGO
MESILLA NM
88046-9040
US

IV. Provider business mailing address

PO BOX 980
MESILLA NM
88046-0980
US

V. Phone/Fax

Practice location:
  • Phone: 915-307-0241
  • Fax: 575-708-2027
Mailing address:
  • Phone: 915-307-0241
  • Fax: 575-708-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: