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General NPI Number Information
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NPI Number | 1386875151
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Entity Type | Individual
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Provider Name | MARY ANNE LITTLE LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/28/2009
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 1418 LUISA ST SUITE 5A
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City | SANTA FE
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State | NM
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Zip | 87505-4091
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Country | US
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Telephone | 505-795-6868
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Fax |
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Provider Business Mailing Address
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Address Line | 5 TAOS TRL N
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City | CORRALES
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State | NM
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Zip | 87048-9660
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Country | US
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Telephone | 505-670-7312
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Fax |
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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 | 004136
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW11166
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C-09378
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License Number State | NM
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