Healthcare Provider Details

I. General information

NPI: 1932370137
Provider Name (Legal Business Name): MARIA DRAKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIA DRAKE LISW

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/13/2012
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 NumberI-07350
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: