MEDICARE: LISA KOFFMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	M-08397	NM

General Provider Information

NPI Number	:	1164829230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA KOFFMAN

Provider Business Mailing Address
First Line	:	1501 SAN PEDRO DR SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-5153
Country	:	US
Telephone Number	:	505-975-5786
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 SAN PEDRO DR SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-5153
Country	:	US
Telephone Number	:	505-975-5786
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2014
Last Update Date	:	06/23/2026

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Directions to “ LISA KOFFMAN ” Practice Location

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