Healthcare Provider Details

I. General information

NPI: 1316597370
Provider Name (Legal Business Name): ANGELA ROMERO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 09/11/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 CAMINO DE LA PLACITA
TAOS NM
87571-5951
US

IV. Provider business mailing address

PO BOX 706
ARROYO SECO NM
87514-0706
US

V. Phone/Fax

Practice location:
  • Phone: 575-737-6115
  • Fax:
Mailing address:
  • Phone: 575-741-1492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberM09247
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: