Healthcare Provider Details

I. General information

NPI: 1952830648
Provider Name (Legal Business Name): MARJORIE S MOCK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARGIE S MOCK

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 06/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 GIBSON BLVD SE 4TH FLOOR
ALBUQUERQUE NM
87108-4729
US

IV. Provider business mailing address

3102 WEST END AVE SUITE 1000
NASHVILLE TN
37203-1324
US

V. Phone/Fax

Practice location:
  • Phone: 505-254-4500
  • Fax: 505-266-0838
Mailing address:
  • Phone: 505-254-4500
  • Fax: 505-266-0838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberC-06896
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: