Healthcare Provider Details

I. General information

NPI: 1366889982
Provider Name (Legal Business Name): CYNTHIA MEYERS-GRAVES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 MOON ST NE
ALBUQUERQUE NM
87111-4619
US

IV. Provider business mailing address

966 ALAMEDA RD NW
ALBUQUERQUE NM
87114-1902
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-4735
  • Fax:
Mailing address:
  • Phone: 505-299-4735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberM-3772
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: