Individual
MR. JOSEPH MARION LACAYO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LISW
Contact information
Practice address
513 WILLIAMS ST BLDG 15, GALLUP, NM 87301-4799
(505) 722-3760
(505) 722-0723
Mailing address
758 PATTON DR, GALLUP, NM 87301-4784
(505) 399-8197
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I-2669
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
56825374
—
NM
Enumeration date
03/01/2007
Last updated
12/04/2014
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