Healthcare Provider Details

I. General information

NPI: 1649285115
Provider Name (Legal Business Name): LISA MORAD-MCCOY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA MARIE MORAD-MCCOY LCSW

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 INDIAN SCHOOL RD NE STE 325
ALBUQUERQUE NM
87110
US

IV. Provider business mailing address

933 BRADBURY DR SE SUITE 2222
ALBUQUERQUE NM
87106-4374
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-6238
  • Fax: 505-272-1876
Mailing address:
  • Phone: 505-272-3120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-4298
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: