MEDICARE: LISA KOFFMAN LCSW 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	:	1558221879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA KOFFMAN LCSW LLC

Provider Business Mailing Address
First Line	:	1812 MORNINGRISE PL SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-4520
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1021 CARLISLE BLVD SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-1642
Country	:	US
Telephone Number	:	505-908-1540
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER
Name	:	LISA ANN KOFFMAN
Credential	:	LCSW
Telephone Number	:	505-908-1540

Provider Enumeration Date	:	11/18/2025
Last Update Date	:	04/14/2026

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