Healthcare Provider Details

I. General information

NPI: 1962772400
Provider Name (Legal Business Name): MARCY A. HAIG LISW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2074 GALISTEO STR. STE. A1
SANTA FE NM
87505-2104
US

IV. Provider business mailing address

2074 GALISTEO STR. STE A1
SANTA FE NM
87505-2104
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: MS. MARCY A. HAIG
Title or Position: LICENSED INDEPENDENT SOCIAL WORKER
Credential: LISW
Phone: 505-983-6432