=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699937615
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAULA ZERFOSS, LCSW INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2008
-----------------------------------------------------
Last Update Date | 06/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13 CALLE DE MONTANAS
-----------------------------------------------------
City | SANTA FE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87507-7903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-474-9299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13 CALLE DE MONTANAS
-----------------------------------------------------
City | SANTA FE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87507-7903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-474-9299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. PAULA ZERFOSS
-----------------------------------------------------
Credential | LCSW, LISW, MSW
-----------------------------------------------------
Telephone | 505-474-9299
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | I-06504
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------