Provider Demographics
NPI:1588127781
Name:ELMQUIST, AMY ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:ELMQUIST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:ELMQUIST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:44 LAMY DOWNS
Mailing Address - Street 2:
Mailing Address - City:LAMY
Mailing Address - State:NM
Mailing Address - Zip Code:87540-9647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44 LAMY DOWNS
Practice Address - Street 2:
Practice Address - City:LAMY
Practice Address - State:NM
Practice Address - Zip Code:87540-9647
Practice Address - Country:US
Practice Address - Phone:505-216-6728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-13
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-107851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical