Healthcare Provider Details

I. General information

NPI: 1801465281
Provider Name (Legal Business Name): CHRISTOPHER MOFFATT LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MEDICAL ARTS AVE NE BLDG 3
ALBUQUERQUE NM
87102-2722
US

IV. Provider business mailing address

1101 MEDICAL ARTS AVE NE BLDG 3
ALBUQUERQUE NM
87102-2722
US

V. Phone/Fax

Practice location:
  • Phone: 505-933-4639
  • Fax:
Mailing address:
  • Phone: 505-933-4639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-11631
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: