Provider Demographics
NPI:1174623821
Name:CRARY, MARJORIE ANN (MSW)
Entity type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:ANN
Last Name:CRARY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 LOS ARBOLES CIR
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-3212
Mailing Address - Country:US
Mailing Address - Phone:505-927-1652
Mailing Address - Fax:505-747-7413
Practice Address - Street 1:415 N PASEO DE ONATE
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2619
Practice Address - Country:US
Practice Address - Phone:505-927-1652
Practice Address - Fax:505-747-7413
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLISW I-45221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM34659714Medicaid
NM75182360Medicaid
NM58131OtherPRESBYTERIAN HEALTH CARE