Provider Demographics
NPI:1952659435
Name:GRANADOS, FATIMA A (LMSW)
Entity Type:Individual
Prefix:
First Name:FATIMA
Middle Name:A
Last Name:GRANADOS
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 1:72 GAIL HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88203-8116
Mailing Address - Country:US
Mailing Address - Phone:575-347-3452
Mailing Address - Fax:575-347-5177
Practice Address - Street 1:72 GAIL HARRIS ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-8116
Practice Address - Country:US
Practice Address - Phone:575-347-3452
Practice Address - Fax:575-347-5177
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0175451101YA0400X
NMM-10239104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)