Organization
SU VIDA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL J FITZPATRICK PHD (EXECUTIVE DIRECTOR/CEO)
(505) 954-8777
Entity
Organization
Contact information
Practice address
1601A SAINT MICHAELS DR, SANTA FE, NM 87505-7614
(505) 954-8777
(505) 954-8793
Mailing address
1601A SAINT MICHAELS DR, SANTA FE, NM 87505-7614
(505) 954-8777
(505) 954-8793
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78558
—
NM
01
—
NM600536
VALUE OPTIONS
NM
Enumeration date
07/06/2006
Last updated
08/22/2020
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