Healthcare Provider Details

I. General information

NPI: 1821398843
Provider Name (Legal Business Name): LYNETTE A CURLEY-ROAM LISW, REV.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12836 LOMAS BLVD NE STE. B
ALBUQUERQUE NM
87112-6210
US

IV. Provider business mailing address

4813 GOODRICH AVE NE
ALBUQUERQUE NM
87110-1169
US

V. Phone/Fax

Practice location:
  • Phone: 505-306-6272
  • Fax: 505-212-0520
Mailing address:
  • Phone: 505-306-6272
  • Fax: 505-212-0520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI06558
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: