=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376681544
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANN F FLOSDORF LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2007
-----------------------------------------------------
Last Update Date | 08/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9301 INDIAN SCHOOL RD NE STE 200F
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87112-2884
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-329-6205
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6001 MOON ST NE APT 1523
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87111-1453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-329-6205
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | R026187
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------