Healthcare Provider Details

I. General information

NPI: 1538343314
Provider Name (Legal Business Name): MARGARET AVILA STOREY MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PUEBLO DR
SANTA FE NM
87505
US

IV. Provider business mailing address

PO BOX 33334
SANTA FE NM
87594
US

V. Phone/Fax

Practice location:
  • Phone: 505-986-8111
  • Fax:
Mailing address:
  • Phone: 505-986-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI - 0190
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: