Melissa Hagstrum Lisw PHD

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I-08107 Issued in NM

Legal business name

MELISSA HAGSTRUM LISW PHD

Practice address

901 W San Mateo Rd
D4
Santa Fe, NM 87505-3981

Phone

(505) 660-0403

NPI assigned

Mar 6, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Melissa B. Hagstrum, LISW, PHD

Title

Owner

Phone

(505) 660-0403

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1394064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394064000000",
    "number": "1639595291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 FRASCO RD",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875088842",
            "telephone_number": "505-660-0403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 W SAN MATEO RD",
            "address_2": "D4",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875053981",
            "telephone_number": "505-660-0403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MELISSA HAGSTRUM LISW PHD",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-06",
        "last_updated": "2014-03-06",
        "status": "A",
        "authorized_official_last_name": "HAGSTRUM",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-660-0403",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "LISW, PHD"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NM",
            "license": "I-08107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Santa Fe, NM
• Providers in Santa Fe, NM by specialty
• Clinical Social Worker in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2014; 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.