MEDICARE: MS. LISA MARIE GARZA LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	M-11698	NM

General Provider Information

NPI Number	:	1205400173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA MARIE GARZA LMSW

Provider Business Mailing Address
First Line	:	3553 EVY LN
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-8356
Country	:	US
Telephone Number	:	575-621-6945
Fax Number	:	575-449-4157

Provider Business Practice Location Address
First Line	:	3553 EVY LN
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-8356
Country	:	US
Telephone Number	:	575-621-6945
Fax Number	:	575-449-4157

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2021
Last Update Date	:	05/16/2021

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