Healthcare Provider Details

I. General information

NPI: 1518503283
Provider Name (Legal Business Name): AMANDA CONTRERAS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12015 TIVOLI AVE NE
ALBUQUERQUE NM
87111-5309
US

IV. Provider business mailing address

PO BOX 25704
ALBUQUERQUE NM
87125-0704
US

V. Phone/Fax

Practice location:
  • Phone: 505-298-6896
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberX-11283
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: