Healthcare Provider Details

I. General information

NPI: 1619697620
Provider Name (Legal Business Name): HOPE FORWARD THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 SAN PEDRO DR NE
ALBUQUERQUE NM
87110-4104
US

IV. Provider business mailing address

8027 CAMILLE AVE NW
ALBUQUERQUE NM
87120-5568
US

V. Phone/Fax

Practice location:
  • Phone: 505-550-6869
  • Fax:
Mailing address:
  • Phone: 505-615-3122
  • 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: SAMANTHA CARRILLO
Title or Position: OWNER
Credential:
Phone: 505-550-6869