Healthcare Provider Details

I. General information

NPI: 1912425679
Provider Name (Legal Business Name): MELINDA MICHELLE STERN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 MOON ST NE
ALBUQUERQUE NM
87112-3935
US

IV. Provider business mailing address

PO BOX 57
MORIARTY NM
87035-0057
US

V. Phone/Fax

Practice location:
  • Phone: 505-818-9758
  • Fax:
Mailing address:
  • Phone: 505-226-1523
  • Fax: 505-521-5191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-11079
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: