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NPI Code Detail

MEDICARE: MS. BONNIE BETH CARR LISW

MEDICARE:  MS. BONNIE BETH CARR  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
11041C0700XClinical Social WorkerI2876NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1I-2876OTHERNMINDEPENDENT SOCIAL WORKER

General Provider Information

NPI Number : 1760490304
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BONNIE BETH CARR LISW
Provider Business Mailing Address
First Line : PO BOX 44761
Second Line :
City : RIO RANCHO
State : NM
Zip : 87174-4761
Country : US
Telephone Number : 505-896-7880
Fax Number : 505-994-2482
Provider Business Practice Location Address
First Line : 12 UNSER BLVD SE
Second Line : SUITE B
City : RIO RANCHO
State : NM
Zip : 87124-6300
Country : US
Telephone Number : 505-896-7880
Fax Number : 505-994-2482
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2006
Last Update Date : 07/21/2022

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Directions to “ MS. BONNIE BETH CARR LISW” Practice Location

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