Healthcare Provider Details

I. General information

NPI: 1285289090
Provider Name (Legal Business Name): CAROL A MONTOYA SOCIAL WORKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 BARBARA LOOP SE
RIO RANCHO NM
87124-1000
US

IV. Provider business mailing address

10509 TOLEDO ST NW
ALBUQUERQUE NM
87114-4970
US

V. Phone/Fax

Practice location:
  • Phone: 505-702-8547
  • Fax: 505-702-8604
Mailing address:
  • Phone: 505-280-0777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberX-11143
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: