Individual provider Active NPI

Chloe Denise Edgar, LCSW

  • Clinical Social Worker
  • Albuquerque, NM
National Provider Identifier
1871731315
Registry record updated Sep 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C-08255 Issued in NM
Practice address
6612 Gulton CT NE Ste B
Albuquerque, NM 87109-4407
Phone
(505) 918-8880
Fax
(505) 521-5165
NPI assigned
Jan 21, 2009
Last updated
Sep 4, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X M-07322 NM
Clinical Social Worker 1041C0700X C-08255 NM Primary

Addresses

Primary practice location

6612 Gulton CT NE Ste B
Albuquerque, NM 87109-4407

Mailing address

6612 Gulton CT NE Ste B
Albuquerque, NM 87109-4407
Phone (505) 918-8880

Other identifiers 1

IdentifierTypeStateIssuer
99889579MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190521003044 NM Practitioner - Clinical Social Worker 7012250731 Reassigns benefits to 1 organization
Practice locations: Albuquerque, NM

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2009
Medicare assignment
May accept Medicare assignment
Group practices
Sandia Therapy and Wellness CenterGroup PAC ID 9335599612, 2 clinicians

Practice addresses (Care Compare)

6612 Gulton CT NE
Suite B
Albuquerque, NM 87109-4407
Phone (505) 633-7886

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
M-07322NMMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Sandia Therapy and Wellness Center Clinical CurrentSince Jan 1, 2021 Accepting new patients

Locations

11005 Spain Rd NE
Ste 15
Albuquerque, NM 87111
Phone (217) 419-0807

6612 Gulton Ct NE
Ste B
Albuquerque, NM 87109
Phone (505) 633-7886

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1232496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725408000000",
    "number": "1871731315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6612 GULTON CT NE STE B",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094407",
            "telephone_number": "505-918-8880",
            "fax_number": "505-521-5165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6612 GULTON CT NE STE B",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094407",
            "telephone_number": "505-918-8880",
            "fax_number": "505-521-5165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDGAR",
        "first_name": "CHLOE",
        "middle_name": "DENISE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-21",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NM",
            "license": "M-07322",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NM",
            "license": "C-08255",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "99889579",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.