Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | M-08821 | NM |
NPI | 1003240433 |
---|---|
Provider Name | Anna Marie Gonzales |
First Address | Albuquerque, NM 87112-3935 |
Second Address | Albuquerque, NM 87112-3935 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2013 |
Last Update Date | 04/11/2014 |