Healthcare Provider Details

I. General information

NPI: 1811366966
Provider Name (Legal Business Name): THOMAS JOSEPH HEINE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 TULANE DR SE
ALBUQUERQUE NM
87106-1413
US

IV. Provider business mailing address

3032 MACKLAND AVE NE
ALBUQUERQUE NM
87106-2018
US

V. Phone/Fax

Practice location:
  • Phone: 505-695-0757
  • Fax:
Mailing address:
  • Phone: 505-695-0757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-09319
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: