Healthcare Provider Details

I. General information

NPI: 1689313272
Provider Name (Legal Business Name): WESLEY SINQUAH LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 RIO GRANDE BLVD NW
ALBUQUERQUE NM
87104-2529
US

IV. Provider business mailing address

9208 JAMES PL NE
ALBUQUERQUE NM
87111-3323
US

V. Phone/Fax

Practice location:
  • Phone: 505-830-1871
  • Fax:
Mailing address:
  • Phone: 505-269-7386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-12037
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: