MEDICARE: EFFIE CLAYTON LMSW

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	1041S0200X	School Social Worker	SWB-2025-0581	NM

General Provider Information

NPI Number	:	1346120474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EFFIE CLAYTON LMSW

Provider Business Mailing Address
First Line	:	6400 UPTOWN BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-4202
Country	:	US
Telephone Number	:	505-880-3700
Fax Number	:	505-830-0660

Provider Business Practice Location Address
First Line	:	11800 PRINCESS JEANNE AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-4426
Country	:	US
Telephone Number	:	505-830-3128
Fax Number	:

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

Provider Enumeration Date	:	09/08/2025
Last Update Date	:	09/08/2025

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