Provider Demographics
NPI:1871731315
Name:EDGAR, CHLOE DENISE (LCSW)
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:DENISE
Last Name:EDGAR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6612 GULTON CT NE STE B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4407
Mailing Address - Country:US
Mailing Address - Phone:505-918-8880
Mailing Address - Fax:505-521-5165
Practice Address - Street 1:6612 GULTON CT NE STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4407
Practice Address - Country:US
Practice Address - Phone:505-918-8880
Practice Address - Fax:505-521-5165
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-07322104100000X
NMC-082551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM99889579Medicaid