Provider Demographics
NPI:1386875151
Name:LITTLE, MARY ANNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANNE
Last Name:LITTLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 TAOS TRL N
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-9660
Mailing Address - Country:US
Mailing Address - Phone:505-670-7312
Mailing Address - Fax:
Practice Address - Street 1:1418 LUISA ST
Practice Address - Street 2:SUITE 5A
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4091
Practice Address - Country:US
Practice Address - Phone:505-795-6868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0041361041C0700X
FLSW111661041C0700X
NMC-093781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical