Provider Demographics
NPI:1346037819
Name:CHAVEZ QUINTANA, WYNEMA (LMSW)
Entity type:Individual
Prefix:
First Name:WYNEMA
Middle Name:
Last Name:CHAVEZ QUINTANA
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:WYNEMA
Other - Middle Name:
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7031 CLARK HILLS DR NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-8677
Mailing Address - Country:US
Mailing Address - Phone:505-206-4290
Mailing Address - Fax:
Practice Address - Street 1:4200 MEADOWLARK LN SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1050
Practice Address - Country:US
Practice Address - Phone:505-218-6383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2025-0268104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker