Healthcare Provider Details

I. General information

NPI: 1356670285
Provider Name (Legal Business Name): CYNTHIA JANE SHUMWAY MSW, LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANIE SHUMWAY MSW, LISW

II. Dates (important events)

Enumeration Date: 12/24/2009
Last Update Date: 12/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10501 GOLF COURSE ROAD NW
ALBUQUERQUE NM
87114
US

IV. Provider business mailing address

10501 GOLF COURSE ROAD NW
ALBUQUERQUE NM
87114
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-2369
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-0667
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: