Healthcare Provider Details

I. General information

NPI: 1396487062
Provider Name (Legal Business Name): SHAUNA BEARMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6208 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-1400
US

IV. Provider business mailing address

1201 PARSONS ST NE
ALBUQUERQUE NM
87112-6350
US

V. Phone/Fax

Practice location:
  • Phone: 505-220-1258
  • Fax:
Mailing address:
  • Phone: 505-410-2296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-11937
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: