Healthcare Provider Details

I. General information

NPI: 1285277186
Provider Name (Legal Business Name): AMY KATHRYN NEAL LISW-CP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DR SE
ALBUQUERQUE NM
87108-5180
US

IV. Provider business mailing address

4702 GUADALUPE TRL NW
ALBUQUERQUE NM
87107-3300
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax: 505-256-6414
Mailing address:
  • Phone: 402-210-9143
  • Fax: 505-256-6414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13326
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: