Healthcare Provider Details

I. General information

NPI: 1841564986
Provider Name (Legal Business Name): MARIA B. DRAKE, LISW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2012
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 SILVER AVE SE
ALBUQUERQUE NM
87106-2207
US

IV. Provider business mailing address

7604 CALLE ARMONIA NE
ALBUQUERQUE NM
87113-2368
US

V. Phone/Fax

Practice location:
  • Phone: 505-506-0427
  • Fax:
Mailing address:
  • Phone: 505-506-0427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI07350
License Number StateNM

VIII. Authorized Official

Name: MISS MARIA DRAKE
Title or Position: MANAGER
Credential: L. I. S. W.
Phone: 505-506-0427