Healthcare Provider Details

I. General information

NPI: 1871675140
Provider Name (Legal Business Name): TERESA J GRABER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 03/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 UNSER BLVD NE
RIO RANCHO NM
87124-4045
US

IV. Provider business mailing address

6200 MONTANO PLAZA DR NW APT 1724
ALBUQUERQUE NM
87120-5747
US

V. Phone/Fax

Practice location:
  • Phone: 505-896-0928
  • Fax: 505-896-0585
Mailing address:
  • Phone: 340-201-7173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-05037
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: