Provider Demographics
NPI:1003965179
Name:LEWIS-CHACON, SHARON MARIE (LISW)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:MARIE
Last Name:LEWIS-CHACON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7208 PICKARD AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1412
Mailing Address - Country:US
Mailing Address - Phone:505-550-4016
Mailing Address - Fax:505-865-3268
Practice Address - Street 1:6633 E HIGHWAY 290
Practice Address - Street 2:SUITE 303
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1172
Practice Address - Country:US
Practice Address - Phone:512-637-2040
Practice Address - Fax:512-637-2044
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-30601041C0700X
TX126871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196999001Medicaid