Healthcare Provider Details

I. General information

NPI: 1396876108
Provider Name (Legal Business Name): DAMON LAEMMLE SW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 CAMINO SIERRA VIS 129
SANTA FE NM
87505-1007
US

IV. Provider business mailing address

1475 CLARK RD
SANTA FE NM
87507-5174
US

V. Phone/Fax

Practice location:
  • Phone: 505-467-2504
  • Fax: 505-467-2646
Mailing address:
  • Phone: 505-690-8926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberM05225
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: