Healthcare Provider Details

I. General information

NPI: 1700070471
Provider Name (Legal Business Name): AMY PICKARD SW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 LLIFF RD NW SR MARMON ES
ALBUQUERQUE NM
87120
US

IV. Provider business mailing address

6401 LLIFF RD NW SR MARMON ES
ALBUQUERQUE NM
87120
US

V. Phone/Fax

Practice location:
  • Phone: 505-400-2981
  • Fax:
Mailing address:
  • Phone: 505-400-2981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberX 05948
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: