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General NPI Number Information
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NPI Number | 1972744480
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Entity Type | Individual
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Provider Name | JOHN OLIVER LOVE MSW
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Gender | Male
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Dates
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Enumeration Date | 03/12/2009
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Last Update Date | 03/12/2009
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Provider Practice Location Address
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Address Line | 1501 SAN PEDRO DRIVE SE BHCL 116
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-5154
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Country | US
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Telephone | 505-265-1711
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Fax | 505-767-6020
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Provider Business Mailing Address
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Address Line | 2827 RIO GRANDE BLVD NW APT 1
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-2972
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Country | US
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Telephone | 505-265-1711
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Fax | 505-767-6020
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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 | M-04734
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License Number State | NM
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