Healthcare Provider Details

I. General information

NPI: 1679890826
Provider Name (Legal Business Name): GLORIA F. SALAZAR, LISW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11317 HANNETT AVE NE
ALBUQUERQUE NM
87112-4335
US

IV. Provider business mailing address

11317 HANNETT AVE NE
ALBUQUERQUE NM
87112-4335
US

V. Phone/Fax

Practice location:
  • Phone: 505-250-2217
  • Fax:
Mailing address:
  • Phone: 505-250-2217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberI
License Number StateNM

VIII. Authorized Official

Name: MS. GLORIA F SALAZAR
Title or Position: CLINICAL SOCIAL WORKER/THERAPIST
Credential: LISW
Phone: 505-250-2217