Provider Demographics
NPI:1376991034
Name:CHRISTINE A. FILA LCSW, LLC
Entity Type:Organization
Organization Name:CHRISTINE A. FILA LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-750-3346
Mailing Address - Street 1:PO BOX 833
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88062-0833
Mailing Address - Country:US
Mailing Address - Phone:617-750-3346
Mailing Address - Fax:
Practice Address - Street 1:405 N COOPER ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-4930
Practice Address - Country:US
Practice Address - Phone:617-750-3346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-091051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM18677037Medicaid