Healthcare Provider Details

I. General information

NPI: 1467953570
Provider Name (Legal Business Name): INGRID LUCIA BISBEE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 RIO GRANDE BLVD NW STE G252
ALBUQUERQUE NM
87104-2059
US

IV. Provider business mailing address

901 RIO GRANDE BLVD NW STE G252
ALBUQUERQUE NM
87104-2059
US

V. Phone/Fax

Practice location:
  • Phone: 505-249-2798
  • Fax: 505-254-9911
Mailing address:
  • Phone: 57-028-1125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-11350
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: