Provider Demographics
NPI:1962563478
Name:CHAVEZ-JAMES, BEATRICE TOBY (LISW)
Entity type:Individual
Prefix:MRS
First Name:BEATRICE
Middle Name:TOBY
Last Name:CHAVEZ-JAMES
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:TOBY
Other - Middle Name:
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1700 CERRILLOS RD
Mailing Address - Street 2:BEHAVIORAL HEALTH PROGRAM
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3554
Mailing Address - Country:US
Mailing Address - Phone:505-946-9477
Mailing Address - Fax:505-983-6243
Practice Address - Street 1:1700 CERRILLOS RD
Practice Address - Street 2:BEHAVIORAL HEALTH PROGRAM
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3554
Practice Address - Country:US
Practice Address - Phone:505-946-9477
Practice Address - Fax:505-983-6243
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-02311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH1232Medicaid
NMP66451Medicare ID - Type Unspecified