Healthcare Provider Details

I. General information

NPI: 1265516744
Provider Name (Legal Business Name): ROSLYN S HASBROOK LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROSLYN S LAWTON LISW

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 SOUTHERN BLVD SUITE 204
RIO RANCHO NM
87124-2006
US

IV. Provider business mailing address

PO BOX 44867
RIO RANCHO NM
87174-4867
US

V. Phone/Fax

Practice location:
  • Phone: 505-994-1661
  • Fax: 505-994-1622
Mailing address:
  • Phone: 505-994-1661
  • Fax: 505-994-1622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0652
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: