Provider Demographics
NPI:1134745276
Name:CRAWFORD-REMALY, MATTEA
Entity type:Individual
Prefix:
First Name:MATTEA
Middle Name:
Last Name:CRAWFORD-REMALY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 GIBSON BLVD SE STE 11
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-5182
Mailing Address - Country:US
Mailing Address - Phone:505-705-9460
Mailing Address - Fax:505-982-2462
Practice Address - Street 1:5400 GIBSON BLVD SE STE 11
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-5182
Practice Address - Country:US
Practice Address - Phone:505-982-3113
Practice Address - Fax:505-982-2462
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-106761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical