Carl Quintana, LMSW

Individual provider Active NPI Clinical Social Worker · Socorro, NM

NPI 1982374039 · NPPES record last updated Sep 20, 2021

Key facts

NPI
1982374039
Entity type
Individual (NPI type 1)
Primary specialty
Clinical Social Worker 1041C0700X
License
X-12154 (NM)
Practice address
700 Franklin St
Socorro, NM 87801-4666
Phone
(505) 559-0946
NPI assigned
Sep 20, 2021
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
X-12154NMMDClinical Social Worker

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker
Group: 193400000X SINGLE SPECIALTY GROUP
1041C0700X X-12154 NM Yes

Addresses

Primary practice location

700 Franklin St
Socorro, NM 87801-4666

Mailing address

3 Valle de Paz Cir
Belen, NM 87002-7565

Other providers in Socorro, NM

All providers in Socorro, NM · Clinical Social Worker in New Mexico

Sources for this page

Verify at the official NPI Registry.