Provider Demographics
NPI:1205900834
Name:NUNEZ, VIOLANDA THERESA (SOCIAL WORKER)
Entity type:Individual
Prefix:MS
First Name:VIOLANDA
Middle Name:THERESA
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 APACHE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3212
Mailing Address - Country:US
Mailing Address - Phone:505-438-0035
Mailing Address - Fax:505-438-0051
Practice Address - Street 1:1316 APACHE AVE
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3212
Practice Address - Country:US
Practice Address - Phone:505-438-0035
Practice Address - Fax:505-438-0051
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NMI15881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00095199Medicaid