Healthcare Provider Details

I. General information

NPI: 1386301471
Provider Name (Legal Business Name): ANNAI BURROLA MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 07/26/2024
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4117 CHAPARRON PL
SANTA FE NM
87507-2770
US

IV. Provider business mailing address

4117 CHAPARRON PL
SANTA FE NM
87507-2770
US

V. Phone/Fax

Practice location:
  • Phone: 505-570-0940
  • Fax:
Mailing address:
  • Phone: 505-570-0940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2022-1127
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: