Healthcare Provider Details

I. General information

NPI: 1760425961
Provider Name (Legal Business Name): RICHARD L LAWYER LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7027 MONTGOMERY BLVD NE SUITE F
ALBUQUERQUE NM
87109-1589
US

IV. Provider business mailing address

PO BOX 151
JARALES NM
87023-0151
US

V. Phone/Fax

Practice location:
  • Phone: 505-880-0100
  • Fax:
Mailing address:
  • Phone: 505-861-5656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-04856
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: