Healthcare Provider Details

I. General information

NPI: 1073010658
Provider Name (Legal Business Name): ANDREA BUSICH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

11500 ROSEMONT AVE NE
ALBUQUERQUE NM
87112-5643
US

V. Phone/Fax

Practice location:
  • Phone: 505-433-7561
  • Fax:
Mailing address:
  • Phone: 505-573-1113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2022-0969
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2025-1261
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: