Healthcare Provider Details

I. General information

NPI: 1811481179
Provider Name (Legal Business Name): KRISTIN MUNIZ LCSW, CSOTP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SAN PEDRO DR NE
ALBUQUERQUE NM
87110-6734
US

IV. Provider business mailing address

1350 MANZANITA CT SE
RIO RANCHO NM
87124-2819
US

V. Phone/Fax

Practice location:
  • Phone: 888-771-1531
  • Fax:
Mailing address:
  • Phone: 575-418-3597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2023-0021
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: