Provider Demographics
NPI:1912312778
Name:MORAN, GAIL FRANCES (MSW)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:FRANCES
Last Name:MORAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2425
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-2425
Mailing Address - Country:US
Mailing Address - Phone:575-779-4197
Mailing Address - Fax:
Practice Address - Street 1:107 PLAZA GARCIA STE C
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6256
Practice Address - Country:US
Practice Address - Phone:575-779-4197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8641041C0700X
NE5851041C0700X
NMC-096241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM62753703Medicaid