Healthcare Provider Details

I. General information

NPI: 1700114832
Provider Name (Legal Business Name): CAREY BENENSON TAUSSIG LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MOYA LN
SANTA FE NM
87508-8869
US

IV. Provider business mailing address

1751 OLD PECOS TRL STE. N
SANTA FE NM
87505-4706
US

V. Phone/Fax

Practice location:
  • Phone: 505-699-7964
  • Fax:
Mailing address:
  • Phone: 505-989-7490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number5575
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: