Provider Demographics
NPI:1275899684
Name:HINOJOS, EUGENE I JR (LISW)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:I
Last Name:HINOJOS
Suffix:JR
Gender:M
Credentials:LISW
Other - Prefix:MR
Other - First Name:EUGENE
Other - Middle Name:
Other - Last Name:HINOJOS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:LMSW, LADAC
Mailing Address - Street 1:2595 WEST HIGHWAY 66
Mailing Address - Street 2:
Mailing Address - City:GRANTS
Mailing Address - State:NM
Mailing Address - Zip Code:87020
Mailing Address - Country:US
Mailing Address - Phone:505-285-5451
Mailing Address - Fax:505-285-6436
Practice Address - Street 1:2595 WEST HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020
Practice Address - Country:US
Practice Address - Phone:505-285-5451
Practice Address - Fax:505-285-6436
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-07609101YM0800X
NMI-085471041C0700X
NM0141591101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM99852390Medicaid