Provider Demographics
NPI:1760664890
Name:HINRICHS, CARL R (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:R
Last Name:HINRICHS
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 1:914 N CANAL ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-5110
Mailing Address - Country:US
Mailing Address - Phone:575-887-4663
Mailing Address - Fax:575-628-0676
Practice Address - Street 1:2800 SAN MATEO BLVD NE STE 100
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110
Practice Address - Country:US
Practice Address - Phone:505-884-0146
Practice Address - Fax:505-884-2004
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-069281041C0700X
NMI-069281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM79508367Medicaid