1154434934 NPI number — MS. CAROL HELEN NEWTON LISW

Table of content: MS. CAROL HELEN NEWTON LISW (NPI 1154434934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154434934 NPI number — MS. CAROL HELEN NEWTON LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEWTON
Provider First Name:
CAROL
Provider Middle Name:
HELEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LISW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154434934
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 CARLISLE BLVD NE STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87110-1697
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-238-7128
Provider Business Mailing Address Fax Number:
505-256-3240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 CARLISLE BLVD NE STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87110-1697
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-238-7128
Provider Business Practice Location Address Fax Number:
505-256-3240
Provider Enumeration Date:
08/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C-04729 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 27704513 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201044865 . This is a "PRESBYTERIAN HEALTH CARE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 600795776 . This is a "MAGELLAN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: NM100824 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com