Healthcare Provider Details

I. General information

NPI: 1942475769
Provider Name (Legal Business Name): CLAIRE VERONICA MCMAHON THOMAS LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 06/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 INDIAN SCHOOL RD NE SUITE 103
ALBUQUERQUE NM
87106-2653
US

IV. Provider business mailing address

PO BOX 4114
ALBUQUERQUE NM
87196-4114
US

V. Phone/Fax

Practice location:
  • Phone: 505-252-2185
  • Fax:
Mailing address:
  • Phone: 505-252-2185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-3797
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI3797
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: