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General NPI Number Information
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NPI Number | 1871864967
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Entity Type | Individual
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Provider Name | FLETCHER BROOK WOOD LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/20/2012
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 6014 PRINCESS JEANNE AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-5921
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Country | US
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Telephone | 505-908-6013
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Fax |
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Provider Business Mailing Address
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Address Line | 800 BRADBURY DR SE STE 116
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4310
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Country | US
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Telephone | 505-272-1476
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C-10597
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License Number State | NM
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