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General NPI Number Information
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NPI Number | 1174623821
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Entity Type | Individual
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Provider Name | MARJORIE ANN CRARY MSW
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Gender | Female
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Dates
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Enumeration Date | 09/23/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 415 N PASEO DE ONATE
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City | ESPANOLA
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State | NM
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Zip | 87532-2619
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Country | US
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Telephone | 505-927-1652
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Fax | 505-747-7413
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Provider Business Mailing Address
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Address Line | 1032 LOS ARBOLES CIR
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City | ESPANOLA
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State | NM
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Zip | 87532-3212
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Country | US
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Telephone | 505-927-1652
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Fax | 505-747-7413
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LISW I-4522
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License Number State | NM
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