Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | C-11109 | NM |
N | 1041C0700X | Clinical Social Worker | LMSW-13635 | AZ |
NPI | 1003179094 |
---|---|
Provider Name | Mrs. Danelle New |
First Address | Albuquerque, NM 87102-2367 |
Second Address | Albuquerque, NM 87102-2367 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2012 |
Last Update Date | 06/10/2020 |