Healthcare Provider Details

I. General information

NPI: 1316123482
Provider Name (Legal Business Name): JOANNA GAWNE MAGEE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2008
Last Update Date: 01/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 PASEO DE PERALTA
SANTA FE NM
87501-4391
US

IV. Provider business mailing address

PO BOX 2267
SANTA FE NM
87504-2267
US

V. Phone/Fax

Practice location:
  • Phone: 505-231-2778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-06391
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: