Healthcare Provider Details

I. General information

NPI: 1679113245
Provider Name (Legal Business Name): TRINA ZAHLLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 HUPMOBILE DR NE
ALBUQUERQUE NM
87123-1875
US

IV. Provider business mailing address

1129 HUPMOBILE DR NE
ALBUQUERQUE NM
87123-1875
US

V. Phone/Fax

Practice location:
  • Phone: 505-750-0744
  • Fax:
Mailing address:
  • Phone: 505-750-0744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-09883
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: