Healthcare Provider Details

I. General information

NPI: 1447723622
Provider Name (Legal Business Name): TABITHA DENNY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 W 2ND ST STE 4
ROSWELL NM
88201-4671
US

IV. Provider business mailing address

2105 S PENNSYLVANIA AVE UNIT B
ROSWELL NM
88203-4157
US

V. Phone/Fax

Practice location:
  • Phone: 919-255-0136
  • Fax:
Mailing address:
  • Phone: 919-255-0136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-10426
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: