=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598886509
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MERION HAWORTH M.S.W., L.C.S.W.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2007
-----------------------------------------------------
Last Update Date | 01/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9219 RIVERBEND AVE SW
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87121-5411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-270-9282
-----------------------------------------------------
Fax | 505-821-9060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9219 RIVERBEND AVE SW
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87121-5411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-270-9282
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | C-0083
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------