Healthcare Provider Details

I. General information

NPI: 1427093020
Provider Name (Legal Business Name): MARTHA R HAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 05/20/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 LAS ESTANCIAS DR. SW
ALBUQUERQUE NM
87121-5504
US

IV. Provider business mailing address

PO BOX 26666 PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-462-7777
  • Fax: 505-462-7880
Mailing address:
  • Phone: 505-923-6770
  • Fax: 505-923-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-3955
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: