Individual
MARTHA MCGOWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1202 HIGHWAY 60 BLDG D, SOCORRO, NM 87801-3914
(575) 838-4690
Mailing address
PO BOX 26666, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
C-11546
NM
1041C0700X
Clinical Social Worker
Primary
C-11546
NM
Other
Enumeration date
01/19/2021
Last updated
04/29/2021
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