Active NPI
Christine Renee Tillman, LMSW
- Social Worker
- Grants, NM
National Provider Identifier
1265289193
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- SWB-2024-0023
- Practice address
- 1040 Sakelares Blvd
Grants, NM 87020-3819 - Phone
- (505) 876-1890
- NPI assigned
- Apr 30, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | SWB-2024-0023 | NM | Primary |
Addresses
Primary practice location
1040 Sakelares Blvd
Grants, NM 87020-3819
Mailing address
13012 Blackstone Rd NE
Albuquerque, NM 87111-3006
Phone (505) 290-5716
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SWB-2024-0023 | NM | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1714435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715126400000",
"number": "1265289193",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13012 BLACKSTONE RD NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871113006",
"telephone_number": "505-290-5716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1040 SAKELARES BLVD",
"city": "GRANTS",
"state": "NM",
"postal_code": "870203819",
"telephone_number": "505-876-1890"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TILLMAN",
"first_name": "CHRISTINE",
"middle_name": "RENEE",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-04-30",
"last_updated": "2024-05-08",
"certification_date": "2024-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NM",
"license": "SWB-2024-0023",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grants, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.