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General NPI Number Information
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NPI Number | 1194048447
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Entity Type | Organization
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Legal Business Name | ELLEN J SHABSHAI FOX, LISW
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Dates
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Enumeration Date | 03/01/2010
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Last Update Date | 03/01/2010
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Provider Practice Location Address
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Address Line | 2400 CALLE AMELIA
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City | SANTA FE
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State | NM
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Zip | 87505-6280
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Country | US
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Telephone | 505-699-4312
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 CALLE AMELIA
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City | SANTA FE
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State | NM
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Zip | 87505-6280
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Country | US
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Telephone | 505-699-4312
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. ELLEN J SHABSHAI FOX
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Credential | 5056994312
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Telephone | 505-699-4312
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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 | I06240
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License Number State | NM
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