MEDICARE: MS. ELIZABETH MARIE WIENS LCSW C-10072

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	1041C0700X	Clinical Social Worker	C-10072	NM

General Provider Information

NPI Number	:	1245429257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH MARIE WIENS LCSW C-10072

Provider Business Mailing Address
First Line	:	13104 NEON AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-4866
Country	:	US
Telephone Number	:	415-319-3824
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 MARBLE AVENUE NE BUILDING #2
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87131-1132
Country	:	US
Telephone Number	:	505-272-2190
Fax Number	:

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

Provider Enumeration Date	:	10/16/2007
Last Update Date	:	07/13/2023

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