Provider Demographics
NPI:1659391936
Name:MAHMUD-GHAZI, ARIANE HEILA (LCSW, LMT, SEP)
Entity Type:Individual
Prefix:MS
First Name:ARIANE
Middle Name:HEILA
Last Name:MAHMUD-GHAZI
Suffix:
Gender:F
Credentials:LCSW, LMT, SEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 YOUNG ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3504
Mailing Address - Country:US
Mailing Address - Phone:505-570-1607
Mailing Address - Fax:505-995-0021
Practice Address - Street 1:1422 4TH ST STE C
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-570-1607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-078051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM27984567Medicaid