Healthcare Provider Details

I. General information

NPI: 1700065497
Provider Name (Legal Business Name): DENISE DUMESNIL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DENISE FRANK

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 PASEO DEL CANON W STE A
TAOS NM
87571-6943
US

IV. Provider business mailing address

PO BOX 1274
EL PRADO NM
87529-1274
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-1125
  • Fax:
Mailing address:
  • Phone: 575-613-5489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-09097
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: