Healthcare Provider Details

I. General information

NPI: 1154504777
Provider Name (Legal Business Name): SHERRY LYNN LEBEZNICK BROWN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 4TH ST NW STE H
LOS RANCHOS NM
87107-5800
US

IV. Provider business mailing address

6501 4TH ST NW STE H
LOS RANCHOS NM
87107-5800
US

V. Phone/Fax

Practice location:
  • Phone: 505-730-6735
  • Fax:
Mailing address:
  • Phone: 505-730-6735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-07730
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: