Healthcare Provider Details

I. General information

NPI: 1982127353
Provider Name (Legal Business Name): TRICIA ANN SHELL MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 09/08/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 BECKNER ROAD
SANTA FE NM
87507
US

IV. Provider business mailing address

4730 BECKNER ROAD
SANTA FE NM
87507
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-4500
  • Fax: 505-443-8313
Mailing address:
  • Phone: 505-989-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-11512
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: