Healthcare Provider Details

I. General information

NPI: 1033431440
Provider Name (Legal Business Name): LISA LYNNE HEWITT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 PROSPECT PL NE STE 100
ALBUQUERQUE NM
87110
US

IV. Provider business mailing address

7001 PROSPECT PL NE STE 100
ALBUQUERQUE NM
87110
US

V. Phone/Fax

Practice location:
  • Phone: 505-823-4530
  • Fax: 505-823-4538
Mailing address:
  • Phone: 505-823-4530
  • Fax: 505-823-4538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-3823
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: