Provider Demographics
NPI:1437754983
Name:GIUDICI, MICHAEL MASSIMO (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MASSIMO
Last Name:GIUDICI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6604
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502-6604
Mailing Address - Country:US
Mailing Address - Phone:505-424-3119
Mailing Address - Fax:
Practice Address - Street 1:1925 ASPEN DR STE 101A
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5579
Practice Address - Country:US
Practice Address - Phone:505-424-3119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2023-10791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical