Provider Demographics
NPI:1073820122
Name:SERNA, PATRICIA (LISW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:SERNA
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:PO BOX 617
Mailing Address - Street 2:
Mailing Address - City:CHAMA
Mailing Address - State:NM
Mailing Address - Zip Code:87520-0617
Mailing Address - Country:US
Mailing Address - Phone:575-756-2327
Mailing Address - Fax:575-756-1897
Practice Address - Street 1:16542 HWY 84
Practice Address - Street 2:
Practice Address - City:CHAMA
Practice Address - State:NM
Practice Address - Zip Code:87520-0617
Practice Address - Country:US
Practice Address - Phone:575-756-2327
Practice Address - Fax:575-756-1897
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-01751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical