MEDICARE: LYNDA K KARLEY LISW

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	1041C0700X	Clinical Social Worker	007205	IA

General Provider Information

NPI Number	:	1386899938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDA K KARLEY LISW

Provider Business Mailing Address
First Line	:	PO BOX 28164
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87592-8164
Country	:	US
Telephone Number	:	402-717-4390
Fax Number	:	402-717-4280

Provider Business Practice Location Address
First Line	:	428 LOS LENTES RD SE
Second Line	:
City	:	LOS LUNAS
State	:	NM
Zip	:	87031-6018
Country	:	US
Telephone Number	:	505-865-3350
Fax Number	:	505-365-1006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/24/2008
Last Update Date	:	02/04/2025

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