Healthcare Provider Details

I. General information

NPI: 1265795231
Provider Name (Legal Business Name): TEMPIE JULIANO LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2012
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 E PALACE AVE APT B
SANTA FE NM
87501-6410
US

IV. Provider business mailing address

645 E PALACE AVE APT B
SANTA FE NM
87501-6410
US

V. Phone/Fax

Practice location:
  • Phone: 505-553-0444
  • Fax:
Mailing address:
  • Phone: 505-553-0444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number37353
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-08764
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: