Healthcare Provider Details

I. General information

NPI: 1255674727
Provider Name (Legal Business Name): CARLA JEANNE TENORIO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 RODEO PARK DR W
SANTA FE NM
87505-6351
US

IV. Provider business mailing address

2960 RODEO PARK DR W
SANTA FE NM
87505-6351
US

V. Phone/Fax

Practice location:
  • Phone: 505-946-1405
  • Fax: 505-992-3141
Mailing address:
  • Phone: 505-946-1405
  • Fax: 505-992-3141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-07623
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: