Healthcare Provider Details

I. General information

NPI: 1114520368
Provider Name (Legal Business Name): MORGAN A FAULKNER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 05/16/2024
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 GALISTEO ST, STE E2
SANTA FE NM
87505-4849
US

IV. Provider business mailing address

2019 GALISTEO ST, STE E2
SANTA FE NM
87505-4849
US

V. Phone/Fax

Practice location:
  • Phone: 505-695-1022
  • Fax: 505-247-1020
Mailing address:
  • Phone: 505-695-1022
  • Fax: 505-247-1020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-11304
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: