Healthcare Provider Details

I. General information

NPI: 1972744480
Provider Name (Legal Business Name): JOHN OLIVER LOVE MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOHN OLIVER LOVE LMSW

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DRIVE SE BHCL 116
ALBUQUERQUE NM
87108-5154
US

IV. Provider business mailing address

2827 RIO GRANDE BLVD NW APT 1
ALBUQUERQUE NM
87107-2972
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax: 505-767-6020
Mailing address:
  • Phone: 505-265-1711
  • Fax: 505-767-6020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-04734
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: