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General NPI Number Information
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NPI Number | 1871624734
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Entity Type | Individual
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Provider Name | NANCI LEE MON LISW
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Gender | Female
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1300 CAMINO SIERRA VISTA BF YOUNG PROFESSIONAL BLDG.
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City | SANTA FE
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State | NM
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Zip | 87505
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Country | US
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Telephone | 505-467-2503
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Fax | 505-989-5568
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Provider Business Mailing Address
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Address Line | PO BOX 9917
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City | SANTA FE
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State | NM
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Zip | 87504-5917
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Country | US
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Telephone | 505-982-3812
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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 | I-0126
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License Number State | NM
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