Healthcare Provider Details

I. General information

NPI: 1134714249
Provider Name (Legal Business Name): ELIZABETH CAROVILLANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 2ND ST STE 28
SANTA FE NM
87505-3801
US

IV. Provider business mailing address

1807 2ND ST STE 28
SANTA FE NM
87505-3801
US

V. Phone/Fax

Practice location:
  • Phone: 505-690-0040
  • Fax:
Mailing address:
  • Phone: 505-690-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2024-0851
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: