Healthcare Provider Details

I. General information

NPI: 1962607028
Provider Name (Legal Business Name): MELODY FILL SW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 SEVEN BAR LOOP RD NW SEVEN BAR ES
ALBUQUERQUE NM
87114-5600
US

IV. Provider business mailing address

4501 SEVEN BAR LOOP RD NW SEVEN BAR ES
ALBUQUERQUE NM
87114-5600
US

V. Phone/Fax

Practice location:
  • Phone: 505-899-2797
  • Fax:
Mailing address:
  • Phone: 505-899-2797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberI 2519
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: