Provider Demographics
NPI:1386772879
Name:ALONZO, ARLENE (LMSW)
Entity type:Individual
Prefix:
First Name:ARLENE
Middle Name:
Last Name:ALONZO
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 1:9400 BENAVIDES RD SW
Mailing Address - Street 2:TRUMAN MS
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-7910
Mailing Address - Country:US
Mailing Address - Phone:505-836-3030
Mailing Address - Fax:
Practice Address - Street 1:9400 BENAVIDES RD SW
Practice Address - Street 2:TRUMAN MS
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-7910
Practice Address - Country:US
Practice Address - Phone:505-836-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM 34601041S0200X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM30788072Medicaid