Provider Demographics
NPI:1831322098
Name:CHACON, AUDREY (LMSW)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:CHACON
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 1:4101 BARBARA LOOP SE STE C
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1011
Mailing Address - Country:US
Mailing Address - Phone:505-933-1978
Mailing Address - Fax:575-339-2780
Practice Address - Street 1:4101 BARBARA LOOP SE STE C
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1011
Practice Address - Country:US
Practice Address - Phone:505-933-1978
Practice Address - Fax:575-339-2780
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2025-0141104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker