Provider Demographics
NPI:1811022098
Name:SALAZAR, GLORIA FRANKLIN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:FRANKLIN
Last Name:SALAZAR
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 1:11317 HANNETT AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-4335
Mailing Address - Country:US
Mailing Address - Phone:505-250-2217
Mailing Address - Fax:
Practice Address - Street 1:11317 HANNETT AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-4335
Practice Address - Country:US
Practice Address - Phone:505-250-2217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-06241104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM44676379Medicaid
NMM-06241OtherLICENSED MASTER SW