MEDICARE: MARIA OLGA CABADA LISW

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	I-07316	NM

General Provider Information

NPI Number	:	1346531035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA OLGA CABADA LISW

Provider Business Mailing Address
First Line	:	301 PERKINS DR STE B
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-3248
Country	:	US
Telephone Number	:	575-526-6682
Fax Number	:	575-647-3777

Provider Business Practice Location Address
First Line	:	1080 MED PARK DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-3226
Country	:	US
Telephone Number	:	575-647-3773
Fax Number	:	575-647-3777

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

Provider Enumeration Date	:	04/28/2011
Last Update Date	:	04/28/2011

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