Provider Demographics
NPI:1962772400
Name:MARCY A. HAIG LISW LLC
Entity type:Organization
Organization Name:MARCY A. HAIG LISW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED INDEPENDENT SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAIG
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-983-6432
Mailing Address - Street 1:2074 GALISTEO STR. STE A1
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2104
Mailing Address - Country:US
Mailing Address - Phone:505-983-6432
Mailing Address - Fax:505-983-6432
Practice Address - Street 1:2074 GALISTEO STR. STE. A1
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2104
Practice Address - Country:US
Practice Address - Phone:505-983-6432
Practice Address - Fax:505-983-6432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-00791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM100062Medicaid
311-56-1382PMedicare UPIN