Charleen M Yellow Kidney
Individual provider Active NPI Clinical Social Worker · Placitas, NM
NPI 1679891600 · NPPES record last updated Feb 2, 2022
Key facts
- NPI
- 1679891600
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- C-09957 (NM)
- Practice address
- 11 Valle Escondido
Placitas, NM 87043-8845 - Phone
- (505) 554-6888
- NPI assigned
- May 14, 2010
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210428000589 | NM | Practitioner - Clinical Social Worker | 0840608097 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Haven Behavioral Services of Albuquerque, LLC | Current |
Accepting new patients |
Locations
5400 Gibson Blvd SE
Ste 4
Albuquerque, NM 87108
Phone (505) 254-4500
3102 West End Ave
Ste 1000
Nashville, TN 37203
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | C-09957 | NM | Yes |
Addresses
Primary practice location
11 Valle Escondido
Placitas, NM 87043-8845
Mailing address
12804 Skyline Rd NE
Albuquerque, NM 87123-3056
Phone (505) 554-6888
Other providers in Placitas, NM
- Neal H Solomon
- Sports Chiropractic & Massage LLC
- Rachael H Tingen
- Lauren Cowden Turner Dolan
- Volcano Vista Psychiatry & Wellness LLC
- Zia Health Solutions LLC
All providers in Placitas, NM · Clinical Social Worker 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 Feb 2, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.