Provider Demographics
NPI:1144522103
Name:CARAFELLI, MARY JO (LMHC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JO
Last Name:CARAFELLI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 MONTAZUMA
Mailing Address - Street 2:#309
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501
Mailing Address - Country:US
Mailing Address - Phone:505-316-5099
Mailing Address - Fax:505-471-3681
Practice Address - Street 1:1919 FIFTH STREET
Practice Address - Street 2:SUITE M AND N
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5402
Practice Address - Country:US
Practice Address - Phone:505-316-5099
Practice Address - Fax:505-471-3681
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0099571101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor