Healthcare Provider Details

I. General information

NPI: 1740850148
Provider Name (Legal Business Name): STEPHANIE THOMAS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 INDIAN SCHOOL RD NE STE 107
ALBUQUERQUE NM
87112-2864
US

IV. Provider business mailing address

4502 OVERLAND ST NE
ALBUQUERQUE NM
87109-2673
US

V. Phone/Fax

Practice location:
  • Phone: 505-358-5059
  • Fax: 505-521-5167
Mailing address:
  • Phone: 505-459-0434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: