Healthcare Provider Details

I. General information

NPI: 1669756185
Provider Name (Legal Business Name): VANYA GARABEDIAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 WASHINGTON ST SE
ALBUQUERQUE NM
87108-2735
US

IV. Provider business mailing address

PO BOX 4642
ALBUQUERQUE NM
87196-4642
US

V. Phone/Fax

Practice location:
  • Phone: 505-980-0954
  • Fax:
Mailing address:
  • Phone: 505-980-0954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC09065
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: