Healthcare Provider Details

I. General information

NPI: 1891090114
Provider Name (Legal Business Name): NANCE PEASE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 MONROE ST NE
ALBUQUERQUE NM
87110-1860
US

IV. Provider business mailing address

3301 MONROE ST NE UNIT J99
ALBUQUERQUE NM
87110-1871
US

V. Phone/Fax

Practice location:
  • Phone: 425-320-9556
  • Fax:
Mailing address:
  • Phone: 425-320-9556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW70017324
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-10301
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: