Healthcare Provider Details

I. General information

NPI: 1083048037
Provider Name (Legal Business Name): MARY JO PICHA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
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

2633 GRANITE AVE NW
ALBUQUERQUE NM
87104-1701
US

V. Phone/Fax

Practice location:
  • Phone: 505-366-9106
  • Fax:
Mailing address:
  • Phone: 505-366-9106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberC-09396
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC09396
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: