=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912487521
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VANESSA STROMAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2018
-----------------------------------------------------
Last Update Date | 08/15/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 143 EL PASO RD
-----------------------------------------------------
City | RUIDOSO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-257-2368
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 143 EL PASO RD
-----------------------------------------------------
City | RUIDOSO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88345-6033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-257-2368
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041S0200X
-----------------------------------------------------
Taxonomy Name | School Social Worker
-----------------------------------------------------
License Number | X-10497
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------