Healthcare Provider Details

I. General information

NPI: 1306445945
Provider Name (Legal Business Name): SW THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2020
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2113 ALHAMBRA AVE SW
ALBUQUERQUE NM
87104-1601
US

IV. Provider business mailing address

PO BOX 26372
ALBUQUERQUE NM
87125-6372
US

V. Phone/Fax

Practice location:
  • Phone: 575-770-1073
  • Fax:
Mailing address:
  • Phone: 575-770-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MARI-ANNE CHANEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 505-315-3128