Healthcare Provider Details

I. General information

NPI: 1548439946
Provider Name (Legal Business Name): MAGDALENA CASTANEDA LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 05/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 CERRILLOS RD
SANTA FE NM
87505-3373
US

IV. Provider business mailing address

2325 CERRILLOS RD
SANTA FE NM
87505-3373
US

V. Phone/Fax

Practice location:
  • Phone: 505-438-0010
  • Fax:
Mailing address:
  • Phone: 505-438-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-08635
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberX-08608
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number054185
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: