Ruth Lynne Kelly, LMSW

Individual provider Active NPI Social Worker · To'Hajiilee, NM

NPI 1992999296 · NPPES record last updated Aug 16, 2012

Key facts

NPI
1992999296
Entity type
Individual (NPI type 1)
Primary specialty
Social Worker 104100000X
License
M-06496 (NM)
Practice address
I40 W Exit 131 Highway 56 N
Acl Teen Centers to'Hajiilee Community School
To'Hajiilee, NM 87026
Phone
(505) 908-2377
Fax
(505) 908-2370
NPI assigned
Aug 29, 2007
Sex
Female
Sole proprietor
No

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
M-06496NMMDSocial Worker

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X M-06496 NM Yes

Addresses

Primary practice location

I40 W Exit 131 Highway 56 N
Acl Teen Centers to'Hajiilee Community School
To'Hajiilee, NM 87026

Mailing address

2703 Frontier Ste 120
Unm PRC Acl Teen Centers MSC 11 6145
Albuquerque, NM 87131-0001
Phone (505) 272-4462

Other identifiers

IdentifierTypeStateIssuer
84020229MedicaidNM

Other providers in To'Hajiilee, NM

All providers in To'Hajiilee, NM · Social Worker in New Mexico

Sources for this page

Verify at the official NPI Registry.