Healthcare Provider Details

I. General information

NPI: 1457290868
Provider Name (Legal Business Name): PATRICIA CHANDLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARQUETTE AVE NW
ALBUQUERQUE NM
87102-5340
US

IV. Provider business mailing address

PO BOX 746878
ATLANTA GA
30374-6878
US

V. Phone/Fax

Practice location:
  • Phone: 323-205-7088
  • Fax: 833-419-0181
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2026-0392
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number65500
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: