Healthcare Provider Details

I. General information

NPI: 1225929581
Provider Name (Legal Business Name): JONATHAN MUNIZ LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 SAN PEDRO DR NE BLDG D1
ALBUQUERQUE NM
87110-8905
US

IV. Provider business mailing address

9201 MONTGOMERY BLVD NE STE V
ALBUQUERQUE NM
87111-2470
US

V. Phone/Fax

Practice location:
  • Phone: 505-217-1717
  • Fax:
Mailing address:
  • Phone: 505-507-7984
  • Fax: 505-213-0041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2025-0638
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: