Healthcare Provider Details

I. General information

NPI: 1093024465
Provider Name (Legal Business Name): AMY E MCGRANE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 MENAUL BLVD NE
ALBUQUERQUE NM
87107-1835
US

IV. Provider business mailing address

117 14TH ST SW
ALBUQUERQUE NM
87102-2821
US

V. Phone/Fax

Practice location:
  • Phone: 505-254-0280
  • Fax:
Mailing address:
  • Phone: 505-264-3804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberM-06672
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: