Healthcare Provider Details

I. General information

NPI: 1114535192
Provider Name (Legal Business Name): TROY STEPHEN WEELDREYER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11005 SPAIN RD NE STE 15
ALBUQUERQUE NM
87111-1871
US

IV. Provider business mailing address

7133 SETTLEMENT WAY NW
ALBUQUERQUE NM
87120-2926
US

V. Phone/Fax

Practice location:
  • Phone: 505-552-6661
  • Fax:
Mailing address:
  • Phone: 505-573-9122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2023-0344
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: