Healthcare Provider Details

I. General information

NPI: 1740170240
Provider Name (Legal Business Name): CASEY THOMPSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3504 LA VETA DR NE
ALBUQUERQUE NM
87110-1952
US

IV. Provider business mailing address

3504 LA VETA DR NE
ALBUQUERQUE NM
87110-1952
US

V. Phone/Fax

Practice location:
  • Phone: 505-639-8625
  • Fax:
Mailing address:
  • Phone: 505-639-8625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2024-0998
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: