Healthcare Provider Details

I. General information

NPI: 1639464704
Provider Name (Legal Business Name): SUSAN MARIE BUECHELE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13701 SKYLINE RD NE
ALBUQUERQUE NM
87123-2327
US

IV. Provider business mailing address

5 STEEPLECHASE DR
TIJERAS NM
87059-5011
US

V. Phone/Fax

Practice location:
  • Phone: 505-463-7923
  • Fax: 505-944-1073
Mailing address:
  • Phone: 505-463-7923
  • Fax: 505-944-1073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI08438
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberX-07376
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-07725
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-08438
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: