Healthcare Provider Details

I. General information

NPI: 1659045292
Provider Name (Legal Business Name): IRENE VILLARREAL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 CENTRAL AVE SW
ALBUQUERQUE NM
87102-2803
US

IV. Provider business mailing address

301 MANUEL SANCHEZ PL SW
ALBUQUERQUE NM
87105-6419
US

V. Phone/Fax

Practice location:
  • Phone: 505-414-6502
  • Fax:
Mailing address:
  • Phone: 505-414-6502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberX-12050
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: