Healthcare Provider Details

I. General information

NPI: 1316002371
Provider Name (Legal Business Name): LOLA SOLER SOCIAL WORKER LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 MARQUEZ PLACE #403B
SANTA FE NM
87505
US

IV. Provider business mailing address

810 LOMA BOREAL
SANTA FE NM
87501
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-3687
  • Fax:
Mailing address:
  • Phone: 505-982-3687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10186
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: