Provider Demographics
NPI:1174170955
Name:CAMFIELD, STEPHANIE MICHELE (PROVISIONAL MSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MICHELE
Last Name:CAMFIELD
Suffix:
Gender:F
Credentials:PROVISIONAL MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5323 MENAUL BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3113
Mailing Address - Country:US
Mailing Address - Phone:505-889-3412
Mailing Address - Fax:505-889-3422
Practice Address - Street 1:5323 MENAUL BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3113
Practice Address - Country:US
Practice Address - Phone:505-889-3412
Practice Address - Fax:505-889-3422
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-11044104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMX-11044Medicaid