Healthcare Provider Details

I. General information

NPI: 1083964613
Provider Name (Legal Business Name): FELICIA MAROHN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 SAINT MICHAELS DR SUITE 2
SANTA FE NM
87505-7655
US

IV. Provider business mailing address

411 SAINT MICHAELS DR SUITE 2
SANTA FE NM
87505-7655
US

V. Phone/Fax

Practice location:
  • Phone: 505-231-0035
  • Fax: 505-982-2196
Mailing address:
  • Phone: 505-231-0035
  • Fax: 505-982-2196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-08853
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: