MEDICARE: LAURA GROSSMAN SW

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	I 5638	NM
2	1041S0200X	School Social Worker	I 5638	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447388137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA GROSSMAN SW

Provider Business Mailing Address
First Line	:	7801 CANDELARIA RD NE
Second Line	:	SANDIA HS
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-3757
Country	:	US
Telephone Number	:	505-294-1511
Fax Number	:

Provider Business Practice Location Address
First Line	:	5341 WYOMING BLVD NE
Second Line	:	SUITE B
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-3164
Country	:	US
Telephone Number	:	505-508-0197
Fax Number	:	505-508-0465

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	04/06/2016

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Directions to “ LAURA GROSSMAN SW” Practice Location

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