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General NPI Number Information
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NPI Number | 1073058897
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Entity Type | Individual
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Provider Name | LORI GRANADO LBSW
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Gender | Female
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Dates
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Enumeration Date | 01/03/2017
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Last Update Date | 01/03/2017
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Provider Practice Location Address
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Address Line | 1718 YALE BLVD SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4286
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Country | US
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Telephone | 505-242-3118
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Fax | 505-242-3062
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Provider Business Mailing Address
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Address Line | 11800 MONTGOMERY BLVD NE APT 2066
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-2773
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Country | US
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Telephone | 505-242-3118
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Fax | 505-242-2306
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | B-09668
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License Number State | NM
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