Healthcare Provider Details

I. General information

NPI: 1669701348
Provider Name (Legal Business Name): AMY WONG HOPE MSW/LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 DON GASPAR AVE
SANTA FE NM
87505-2626
US

IV. Provider business mailing address

532 DON GASPAR AVE
SANTA FE NM
87505-2626
US

V. Phone/Fax

Practice location:
  • Phone: 505-660-9435
  • Fax:
Mailing address:
  • Phone: 505-660-9435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number216792
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-08692
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: