Provider Demographics
NPI:1417538489
Name:RAEL, ANTHONY (CSW)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:RAEL
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 TELSTAR LOOP NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-1341
Mailing Address - Country:US
Mailing Address - Phone:505-414-5600
Mailing Address - Fax:
Practice Address - Street 1:1044 TELSTAR LOOP NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-1341
Practice Address - Country:US
Practice Address - Phone:505-414-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator