Provider Demographics
NPI:1457448904
Name:CARBAJAL, ARLENE G (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ARLENE
Middle Name:G
Last Name:CARBAJAL
Suffix:
Gender:F
Credentials:LMSW
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 1349
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88062-1349
Mailing Address - Country:US
Mailing Address - Phone:505-388-4497
Mailing Address - Fax:505-534-1150
Practice Address - Street 1:315 S HUDSON
Practice Address - Street 2:SUITE 9
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061
Practice Address - Country:US
Practice Address - Phone:505-388-4497
Practice Address - Fax:505-534-1150
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-0488101YP2500X, 104100000X
NM1015101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM62404059Medicaid