Provider Demographics
NPI:1306944988
Name:SHOTWELL, JAMES H (LCSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:SHOTWELL
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 1:5033 WHITE OWL WAY NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-0884
Mailing Address - Country:US
Mailing Address - Phone:505-891-1583
Mailing Address - Fax:
Practice Address - Street 1:4004 CARLISLE BLVD NE STE A2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4566
Practice Address - Country:US
Practice Address - Phone:505-891-1583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-38921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM201021113OtherPRESBYTERIAN HEALTH PLAN
NMVNM00212OTOtherVALUEOPTIONS NEW MEXICO
NM25102265Medicaid
NM201021113OtherPRESBYTERIAN HEALTH PLAN