Healthcare Provider Details

I. General information

NPI: 1477043149
Provider Name (Legal Business Name): GEENA TOMMASI, LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2074 GALISTEO ST STE B4
SANTA FE NM
87505-2157
US

IV. Provider business mailing address

1300 CANYON RD UNIT B
SANTA FE NM
87501-6162
US

V. Phone/Fax

Practice location:
  • Phone: 505-795-0368
  • Fax: 844-265-8631
Mailing address:
  • Phone: 505-795-0368
  • Fax: 844-265-8631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-08299
License Number StateNM

VIII. Authorized Official

Name: GEENA TOMMASI
Title or Position: OWNER
Credential: LCSW
Phone: 505-795-0368