Provider Demographics
NPI:1275110363
Name:ANN G MCSPADDEN
Entity Type:Organization
Organization Name:ANN G MCSPADDEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:GREER
Authorized Official - Last Name:MCSPADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-231-9577
Mailing Address - Street 1:13 ENTRADA EMPINADA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87506-0208
Mailing Address - Country:US
Mailing Address - Phone:505-231-9577
Mailing Address - Fax:
Practice Address - Street 1:13 ENTRADA EMPINADA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87506-0208
Practice Address - Country:US
Practice Address - Phone:505-231-9577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000A0351Medicaid