Healthcare Provider Details

I. General information

NPI: 1760255004
Provider Name (Legal Business Name): LAUREN FRANCES BRINCH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W HICKORY ST
DEMING NM
88030-4046
US

IV. Provider business mailing address

901 W HICKORY ST
DEMING NM
88030-4046
US

V. Phone/Fax

Practice location:
  • Phone: 575-546-2174
  • Fax: 575-544-4821
Mailing address:
  • Phone: 575-546-2174
  • Fax: 575-544-4821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2023-1153
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number111446
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: