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NPI Code Detail

MEDICARE: ANNE LIECHTY

MEDICARE: ANNE LIECHTY
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
1104100000XSocial WorkerM-08550NM

General Provider Information

NPI Number : 1871971465
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNE LIECHTY
Provider Business Mailing Address
First Line : 1305 BLAKE RD SW
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87105-4779
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1317 ISLETA BLVD SW
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87105-4035
Country : US
Telephone Number : 505-312-7296
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2015
Last Update Date : 05/14/2015

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Directions to “ ANNE LIECHTY ” Practice Location

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