Healthcare Provider Details

I. General information

NPI: 1861275125
Provider Name (Legal Business Name): KELLY F ZAMORA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 08/18/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 SUDDERTH DR
RUIDOSO NM
88345-6119
US

IV. Provider business mailing address

PO BOX 302
CARRIZOZO NM
88301-0302
US

V. Phone/Fax

Practice location:
  • Phone: 575-257-2368
  • Fax:
Mailing address:
  • Phone: 575-937-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberM-4268
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: