Healthcare Provider Details

I. General information

NPI: 1114901212
Provider Name (Legal Business Name): TROI ALLISON BOULANGER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S. ST. FRANCIS DRIVE UNIT C
SANTA FE NM
87501
US

IV. Provider business mailing address

301 S. ST. FRANCIS DRIVE UNIT C
SANTA FE NM
87501
US

V. Phone/Fax

Practice location:
  • Phone: 207-761-1160
  • Fax: 207-761-1160
Mailing address:
  • Phone: 207-761-1160
  • Fax: 207-761-1160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLC6759
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2025-1303
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: