Healthcare Provider Details

I. General information

NPI: 1982109062
Provider Name (Legal Business Name): ERIN SIBLEY DOERWALD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 OLD SANTA FE TRL STE 1
SANTA FE NM
87505-0398
US

IV. Provider business mailing address

7430 OLD SANTA FE TRL
SANTA FE NM
87505-4574
US

V. Phone/Fax

Practice location:
  • Phone: 505-819-1492
  • Fax:
Mailing address:
  • Phone: 505-819-1492
  • Fax: 505-294-1056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number08-00033470
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: