Healthcare Provider Details

I. General information

NPI: 1023133485
Provider Name (Legal Business Name): DAVID BELFORD LISW, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 PAN AMERICAN FWY NE STE D
ALBUQUERQUE NM
87107-4793
US

IV. Provider business mailing address

PO BOX 6091
ALBUQUERQUE NM
87197-6091
US

V. Phone/Fax

Practice location:
  • Phone: 505-750-1006
  • Fax:
Mailing address:
  • Phone: 505-750-1006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1024428
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-07195
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: