Healthcare Provider Details

I. General information

NPI: 1851708663
Provider Name (Legal Business Name): ELIZABETH COLSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 BECKNER RD
SANTA FE NM
87507-3641
US

IV. Provider business mailing address

36 AVENTURA RD
SANTA FE NM
87508-8744
US

V. Phone/Fax

Practice location:
  • Phone: 505-772-1048
  • Fax:
Mailing address:
  • Phone: 505-603-3091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberX-08727
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-09719
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: