Provider Demographics
NPI:1457987737
Name:CANTU, MARLENE TABITHA (LMSW)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:TABITHA
Last Name:CANTU
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MARLENE
Other - Middle Name:TABITHA
Other - Last Name:CANTU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:SANTA FE FAMILY HEALTH CENTER
Mailing Address - Street 2:4730 BECKNER ROAD
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507
Mailing Address - Country:US
Mailing Address - Phone:505-443-8313
Mailing Address - Fax:505-989-4500
Practice Address - Street 1:4730 BECKNER RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-6351
Practice Address - Country:US
Practice Address - Phone:505-989-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2022-00591041C0700X
104100000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No172V00000XOther Service ProvidersCommunity Health Worker