Healthcare Provider Details

I. General information

NPI: 1447675921
Provider Name (Legal Business Name): SAMANTHA ASPEN GROVES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA WOOD

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 MOON ST NE
ALBUQUERQUE NM
87112-3935
US

IV. Provider business mailing address

3832 CHERAZ RD NE
ALBUQUERQUE NM
87111-3307
US

V. Phone/Fax

Practice location:
  • Phone: 505-271-0329
  • Fax:
Mailing address:
  • Phone: 505-288-9919
  • 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: