MEDICARE: THE AFFIRMARY, LLC

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

General Provider Information

NPI Number	:	1558136077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE AFFIRMARY, LLC

Provider Business Mailing Address
First Line	:	6801 JEFFERSON ST NE
Second Line	:	SUITE 150 PMB 3492
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109
Country	:	US
Telephone Number	:	505-255-1615
Fax Number	:

Provider Business Practice Location Address
First Line	:	6801 JEFFERSON ST NE
Second Line	:	SUITE 150 PMB 3492
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109
Country	:	US
Telephone Number	:	505-255-1615
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	ELLA ALICE BROWN
Credential	:	MSW, LCSW-S
Telephone Number	:	505-255-1615

Provider Enumeration Date	:	11/15/2023
Last Update Date	:	02/02/2024

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