Healthcare Provider Details

I. General information

NPI: 1942686852
Provider Name (Legal Business Name): ANDREA GURULE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 09/03/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CONTACT 2900 LOUISIANA BLVD NE, SUITE B-2
ALBUQUERQUE NM
87110
US

IV. Provider business mailing address

4516 6TH ST NW
ALBUQUERQUE NM
87107-3710
US

V. Phone/Fax

Practice location:
  • Phone: 505-361-1011
  • Fax:
Mailing address:
  • Phone: 505-361-1011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2022-0256
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: