Healthcare Provider Details

I. General information

NPI: 1669445367
Provider Name (Legal Business Name): LYSSA MICHELLE DANEHY LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2006
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOSPITAL LOOP NE SUITE 215
ALBUQUERQUE NM
87109-2129
US

IV. Provider business mailing address

101 HOSPITAL LOOP NE SUITE 101
ALBUQUERQUE NM
87109-2129
US

V. Phone/Fax

Practice location:
  • Phone: 505-463-2685
  • Fax: 866-531-2893
Mailing address:
  • Phone: 505-463-2685
  • Fax: 866-531-2893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-4133
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: