Provider Demographics
NPI:1083654537
Name:NUNEZ, SAMUEL (LCSW)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:NUNEZ
Suffix:
Gender:M
Credentials:LCSW
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 1063
Mailing Address - Street 2:
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-1063
Mailing Address - Country:US
Mailing Address - Phone:575-824-9000
Mailing Address - Fax:866-596-6125
Practice Address - Street 1:101 LIVINGSTON LOOP STE C1
Practice Address - Street 2:
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9753
Practice Address - Country:US
Practice Address - Phone:575-824-9000
Practice Address - Fax:866-596-6125
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-07343104100000X
TX020671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM99436311Medicaid
TX040468307Medicaid
TX040468308Medicaid