Healthcare Provider Details

I. General information

NPI: 1174573877
Provider Name (Legal Business Name): ELLEN M. CURLEY-ROAM LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12836 LOMAS BLVD NE SUITE B
ALBUQUERQUE NM
87112-6210
US

IV. Provider business mailing address

12836 LOMAS BLVD NE SUITE B
ALBUQUERQUE NM
87112-6210
US

V. Phone/Fax

Practice location:
  • Phone: 505-306-6047
  • Fax: 505-883-3083
Mailing address:
  • Phone: 505-306-6047
  • Fax: 505-883-3083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-06489
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: