Healthcare Provider Details

I. General information

NPI: 1689111841
Provider Name (Legal Business Name): A SHARED PATH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2017
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 TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-07730
License Number StateNM

VIII. Authorized Official

Name: SHERRY LEBEZNICK BROWN
Title or Position: CLINICAL DIRECTOR
Credential: LCSW
Phone: 505-730-6735