Healthcare Provider Details

I. General information

NPI: 1124450093
Provider Name (Legal Business Name): ALICIA F APODACA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 CAMINO SIERRA VIS
SANTA FE NM
87505-1007
US

IV. Provider business mailing address

1004 CALLE LA RESOLANA
SANTA FE NM
87507-5113
US

V. Phone/Fax

Practice location:
  • Phone: 505-467-2504
  • Fax:
Mailing address:
  • Phone: 505-438-4560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberM-08149
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: