Healthcare Provider Details

I. General information

NPI: 1487168472
Provider Name (Legal Business Name): MORGAN DUVAL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 BROADWAY BLVD NE STE 500
ALBUQUERQUE NM
87102-2367
US

IV. Provider business mailing address

PO BOX 1637
OWENSBORO KY
42302-1637
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-0701
  • Fax: 270-689-6677
Mailing address:
  • Phone: 270-689-6500
  • Fax: 270-689-6677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-09708
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2023-0426
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: