Healthcare Provider Details

I. General information

NPI: 1952275133
Provider Name (Legal Business Name): JUSTIN WEIGL LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87111-2405
US

IV. Provider business mailing address

1375 N SCOTTSDALE RD STE 200
SCOTTSDALE AZ
85257-3429
US

V. Phone/Fax

Practice location:
  • Phone: 505-879-7535
  • Fax:
Mailing address:
  • Phone: 480-877-9284
  • Fax: 480-452-1976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2025-0434
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: