Provider Demographics
NPI:1336328871
Name:ELEBARIO, RACHAEL (SW)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:ELEBARIO
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 VALDORA RD SW
Mailing Address - Street 2:ERNIE PYLE MS
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-4551
Mailing Address - Country:US
Mailing Address - Phone:505-877-3770
Mailing Address - Fax:
Practice Address - Street 1:1820 VALDORA RD SW
Practice Address - Street 2:ERNIE PYLE MS
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-4551
Practice Address - Country:US
Practice Address - Phone:505-877-3770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-074721041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM69603324Medicaid