Healthcare Provider Details

I. General information

NPI: 1215096276
Provider Name (Legal Business Name): MARGARET V MOORE LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2418 MILES RD SE
ALBUQUERQUE NM
87106-3224
US

IV. Provider business mailing address

2418 MILES RD SE
ALBUQUERQUE NM
87106-3224
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-8915
  • Fax: 505-247-8942
Mailing address:
  • Phone: 505-247-8915
  • Fax: 505-247-8942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberNM1-0004
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: