Healthcare Provider Details

I. General information

NPI: 1952461071
Provider Name (Legal Business Name): MARCY A HAIG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2074 GALISTEO ST SUITE A1
SANTA FE NM
87505
US

IV. Provider business mailing address

2074 GALISTEO ST SUITE A1
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-6432
  • Fax: 505-983-6432
Mailing address:
  • Phone: 505-983-6432
  • Fax: 505-983-6432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-0079
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: