MEDICARE: CALLI FEERER, LCSW LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386218642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALLI FEERER, LCSW LLC

Provider Business Mailing Address
First Line	:	10610 HILGENBERG LN SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87121-3704
Country	:	US
Telephone Number	:	505-515-5561
Fax Number	:

Provider Business Practice Location Address
First Line	:	3610 CAMPUS BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-1314
Country	:	US
Telephone Number	:	505-515-5561
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	CALLI FEERER
Credential	:	LCSW
Telephone Number	:	505-515-5561

Provider Enumeration Date	:	05/19/2021
Last Update Date	:	05/19/2021

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