Provider Demographics
NPI:1538632922
Name:TALTY, CAITLIN EILEEN (LMSW)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:EILEEN
Last Name:TALTY
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 1:330 N ARMIJO ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-2535
Mailing Address - Country:US
Mailing Address - Phone:575-342-2923
Mailing Address - Fax:575-524-4266
Practice Address - Street 1:330 N ARMIJO ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2535
Practice Address - Country:US
Practice Address - Phone:575-342-2923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2022-05101041C0700X
NMM-10848104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM52400263Medicaid