Healthcare Provider Details

I. General information

NPI: 1972601151
Provider Name (Legal Business Name): HANNAH RACHEL JOHNSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5312 JAGUAR DR
SANTA FE NM
87507-1827
US

IV. Provider business mailing address

PO BOX 341
GLORIETA NM
87535-0341
US

V. Phone/Fax

Practice location:
  • Phone: 505-820-0262
  • Fax: 505-820-9220
Mailing address:
  • Phone: 505-757-2422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-05615
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: