| Our Imaginal World, Llc | |
|
245 Rosario Blvd Apt C Santa Fe NM 87501-1373 | |
| (917) 626-5360 | |
| Not Available |
| Full Name | Our Imaginal World, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 245 Rosario Blvd Apt C, Santa Fe, New Mexico |
| Authorized Official Name and Position | Magdalena Karlick (DIRECTOR) |
| Authorized Official Contact | 9176265360 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Our Imaginal World, Llc 245 Rosario Blvd Apt C Santa Fe NM 87501-1373 Ph: (917) 626-5360 | Our Imaginal World, Llc 245 Rosario Blvd Apt C Santa Fe NM 87501-1373 Ph: (917) 626-5360 |
| NPI Number | 1528700770 |
|---|---|
| Provider Enumeration Date | 04/08/2022 |
| Last Update Date | 04/08/2022 |
| Certification Date | 04/08/2022 |
| Medicare PECOS PAC ID | 9739624040 |
|---|---|
| Medicare Enrollment ID | O20240711000403 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528700770 | NPI | - | NPPES |
| 1326276288 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Magdalena Karlick |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326276288 PECOS PAC ID: 3274078597 Enrollment ID: I20240711002325 |
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