Healthcare Provider Details

I. General information

NPI: 1154570968
Provider Name (Legal Business Name): LORI A SMITH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 FRANKLIN RD. NE
RIO RANCHO NM
87144
US

IV. Provider business mailing address

500 LASRE RD. NE
RIO RANCHO NM
87124
US

V. Phone/Fax

Practice location:
  • Phone: 505-338-2526
  • Fax:
Mailing address:
  • Phone: 505-338-2526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberX-06370
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: