Healthcare Provider Details

I. General information

NPI: 1558221879
Provider Name (Legal Business Name): LISA KOFFMAN LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 CARLISLE BLVD SE
ALBUQUERQUE NM
87106-1642
US

IV. Provider business mailing address

1812 MORNINGRISE PL SE
ALBUQUERQUE NM
87108-4520
US

V. Phone/Fax

Practice location:
  • Phone: 505-908-1540
  • Fax:
Mailing address:
  • Phone:
  • 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: LISA ANN KOFFMAN
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 505-908-1540