Individual
MIA G PACHECO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
201 M PUEBLO VIEW ROAD, PENASCO, NM 87553-0127
(575) 779-4279
Mailing address
PO BOX 127, PENASCO, NM 87553-0127
(575) 779-4279
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SWB-2023-0038
NM
171M00000X
Case Manager/Care Coordinator
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Other
Enumeration date
04/25/2023
Last updated
04/25/2023
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