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General NPI Number Information
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NPI Number | 1578528337
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Entity Type | Individual
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Provider Name | MARILOU RENIE TAGLIATELA LMSW
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Gender | Female
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Dates
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Enumeration Date | 04/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 101 N 2ND ST
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City | RATON
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State | NM
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Zip | 87740-3803
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Country | US
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Telephone | 505-445-7090
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Fax |
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Provider Business Mailing Address
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Address Line | 5740 HOUSMAN AVE
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City | PUEBLO
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State | CO
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Zip | 81004-9708
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Country | US
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Telephone | 719-214-2568
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | M-05797
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License Number State | NM
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