Healthcare Provider Details

I. General information

NPI: 1336804848
Provider Name (Legal Business Name): HUDA IBRAHIM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 COMMERCIAL ST NE FL 3
ALBUQUERQUE NM
87102-3453
US

IV. Provider business mailing address

317 COMMERCIAL ST NE FL 3
ALBUQUERQUE NM
87102-3453
US

V. Phone/Fax

Practice location:
  • Phone: 505-705-1740
  • Fax:
Mailing address:
  • Phone: 505-705-1740
  • 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:
Title or Position:
Credential:
Phone: