Healthcare Provider Details

I. General information

NPI: 1811025935
Provider Name (Legal Business Name): BARBARA BRANDON SW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

554 90TH ST SW EDWARD GONZALES ES
ALBUQUERQUE NM
87121-7710
US

IV. Provider business mailing address

554 90TH ST SW EDWARD GONZALES ES
ALBUQUERQUE NM
87121-7710
US

V. Phone/Fax

Practice location:
  • Phone: 505-831-6214
  • Fax:
Mailing address:
  • Phone: 505-831-6214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI 4429
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: