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General NPI Number Information
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NPI Number | 1063889517
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Entity Type | Individual
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Provider Name | MS. LESLIE BECKETT
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Gender | Female
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Dates
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Enumeration Date | 08/31/2015
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Last Update Date | 08/31/2015
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Provider Practice Location Address
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Address Line | 2601 WYOMING BLVD NE STE 208
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-1035
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Country | US
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Telephone | 312-662-2507
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Fax |
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Provider Business Mailing Address
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Address Line | 5819 BOSQUE VISTA DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-8314
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C-08702
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License Number State | NM
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