MEDICARE: MRS. LUCY M. REED LISW

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	I-0148	NM

General Provider Information

NPI Number	:	1366627218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LUCY M. REED LISW

Provider Business Mailing Address
First Line	:	PO BOX 1323
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-1323
Country	:	US
Telephone Number	:	505-454-3900
Fax Number	:	505-454-3900

Provider Business Practice Location Address
First Line	:	727 7TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4238
Country	:	US
Telephone Number	:	505-454-3900
Fax Number	:	505-454-3900

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

Provider Enumeration Date	:	01/09/2008
Last Update Date	:	01/09/2008

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