MEDICARE: DIANA M PACHECO 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	1041S0200X	School Social Worker	M09231	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568936433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA M PACHECO LMSW

Provider Business Mailing Address
First Line	:	68 COYOTE TRL
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87508-8631
Country	:	US
Telephone Number	:	505-629-6334
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 AVENIDA DE LAS CAMPANAS
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-5369
Country	:	US
Telephone Number	:	505-467-1808
Fax Number	:

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

Provider Enumeration Date	:	01/14/2019
Last Update Date	:	01/14/2019

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