Healthcare Provider Details

I. General information

NPI: 1881951341
Provider Name (Legal Business Name): AUTISM AND EARLY INTERVENTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 CAMINO DEL MONTE REY
SANTA FE NM
87505-3977
US

IV. Provider business mailing address

826 CAMINO DEL MONTE REY
SANTA FE NM
87505-3977
US

V. Phone/Fax

Practice location:
  • Phone: 505-577-9515
  • Fax:
Mailing address:
  • Phone: 505-577-9515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number313856
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-06152
License Number StateNM

VIII. Authorized Official

Name: MS. ZOE MIGEL
Title or Position: EXECUTIVE DIRECTOR
Credential: LISW
Phone: 505-577-9515