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General NPI Number Information
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NPI Number | 1255967550
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Entity Type | Organization
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Legal Business Name | CARRIE EBERHARDY, LCSW LLC
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Dates
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Enumeration Date | 03/18/2020
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Last Update Date | 08/11/2020
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Provider Practice Location Address
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Address Line | 3600 CERRILLOS RD STE 724E
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City | SANTA FE
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State | NM
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Zip | 87507-2690
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Country | US
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Telephone | 505-819-3253
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Fax |
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Provider Business Mailing Address
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Address Line | 369 MONTEZUMA AVE # 379
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City | SANTA FE
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State | NM
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Zip | 87501-2835
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Country | US
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Telephone | 505-819-3253
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARRIE EBERHARDY
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Credential | LCSW
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Telephone | 505-819-3253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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