Provider Demographics
NPI:1861275125
Name:ZAMORA, KELLY F (LMSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:F
Last Name:ZAMORA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 302
Mailing Address - Street 2:
Mailing Address - City:CARRIZOZO
Mailing Address - State:NM
Mailing Address - Zip Code:88301-0302
Mailing Address - Country:US
Mailing Address - Phone:575-937-4800
Mailing Address - Fax:
Practice Address - Street 1:2002 SUDDERTH DR
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6119
Practice Address - Country:US
Practice Address - Phone:575-257-2368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-42681041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool