Provider Demographics
NPI:1871158642
Name:CHAVEZ, JULIE (MSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 677
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88062-0677
Mailing Address - Country:US
Mailing Address - Phone:575-388-2414
Mailing Address - Fax:575-590-3041
Practice Address - Street 1:1120 N WEST ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-4600
Practice Address - Country:US
Practice Address - Phone:575-388-2414
Practice Address - Fax:575-388-2457
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMB-09357104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker