Victoria A Carroccio
Individual provider Active NPI Mental Health Counselor · El Prado, NM
NPI 1346853082 · NPPES record last updated Aug 16, 2022
Key facts
- NPI
- 1346853082
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- CCMH0215621 (NM)
- Practice address
- 65 Hwy 522
El Prado, NM 87529 - Phone
- (575) 613-2712
- NPI assigned
- Aug 24, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CCMH0215621 | NM | MD | Mental Health Counselor |
| CMH0193781 | NM | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | CCMH0215621 | NM | Yes |
| Mental Health Counselor | 101YM0800X | CMH0193781 | NM |
Addresses
Primary practice location
65 Hwy 522
El Prado, NM 87529
Mailing address
PO Box 1511
El Prado, NM 87529-1511
Phone (575) 613-2712
Other practice location 1
412 Sipapu St
Taos, NM 87571-6498
Phone (575) 425-3274
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 73725773 | Medicaid | NM |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | http://goldenwillowcounseling.com/ |
Other providers in El Prado, NM
- Sandra Cecelia Bodge
- Deborah D. Brown
- Greta Alene Brown
- Ed Cardenas
- Carrie Nassif PHD LLC
- Catherine Clement
- Julianne Clinton
- Colonias Chiropractic Center Inc
- Caroline Laetitia Colonna
- Elisabeth Jean Coniglio
All providers in El Prado, NM · Mental Health Counselor in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 16, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.