Healthcare Provider Details

I. General information

NPI: 1912657032
Provider Name (Legal Business Name): AMY GRUBELNIK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY ROMERO LMSW

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 CARLISLE BLVD NE STE 207
ALBUQUERQUE NM
87107-4849
US

IV. Provider business mailing address

605 N YORK ST
ARTESIA NM
88210-9684
US

V. Phone/Fax

Practice location:
  • Phone: 575-616-2550
  • Fax:
Mailing address:
  • Phone: 575-616-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2024-0775
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: