Healthcare Provider Details

I. General information

NPI: 1700322146
Provider Name (Legal Business Name): NAOMI MOPPERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8625 GOLF COURSE RD NW STE B2
ALBUQUERQUE NM
87114-5114
US

IV. Provider business mailing address

8625 GOLF COURSE RD NW STE B2
ALBUQUERQUE NM
87114-5114
US

V. Phone/Fax

Practice location:
  • Phone: 505-508-0808
  • Fax: 888-896-8728
Mailing address:
  • Phone: 505-508-0808
  • Fax: 888-896-8728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2023-1309
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: