Victoria A Carroccio

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CCMH0215621 Issued in NM

Practice address

65 Hwy 522
El Prado, NM 87529

Phone

(575) 613-2712

NPI assigned

Aug 24, 2020

Last updated

Aug 16, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1598227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660608000000",
    "number": "1346853082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1511",
            "city": "EL PRADO",
            "state": "NM",
            "postal_code": "875291511",
            "telephone_number": "575-613-2712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 HWY 522",
            "city": "EL PRADO",
            "state": "NM",
            "postal_code": "87529",
            "telephone_number": "575-613-2712"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "412 Sipapu St",
            "address_purpose": "LOCATION",
            "city": "Taos",
            "state": "NM",
            "postal_code": "875716498",
            "country_code": "US",
            "telephone_number": "575-425-3274",
            "fax_number": "575-221-4517",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARROCCIO",
        "first_name": "VICTORIA",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-24",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "CCMH0215621",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "CMH0193781",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "http://goldenwillowcounseling.com/",
            "affiliation": "N",
            "address_1": "412 Sipapu St",
            "city": "Taos",
            "state": "NM",
            "country_code": "US",
            "postal_code": "875716498",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sandra Cecelia Bodge, CASE MANAGER
• Deborah D. Brown, M.A.,CCC-SLP
• Greta Alene Brown, LCSW
• Ed Cardenas, MSW, LISW, CAC
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• Catherine Clement, DC
• Julianne Clinton, CNP
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• Caroline Laetitia Colonna, DOM
• Elisabeth Jean Coniglio

• Mental Health Counselor in El Prado, NM
• Providers in El Prado, NM by specialty
• Mental Health Counselor in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.