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NPI Code Detail

MEDICARE: SUSANNE KEE LISW

MEDICARE: SUSANNE KEE 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
11041C0700XClinical Social WorkerX-05977NM

General Provider Information

NPI Number : 1578759007
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSANNE KEE LISW
Provider Business Mailing Address
First Line : 2311 RANCH CLUB RD.
Second Line : PMB 408
City : SILVER CITY
State : NM
Zip : 88061-6610
Country : US
Telephone Number : 575-388-2414
Fax Number : 575-388-2457
Provider Business Practice Location Address
First Line : 610 N SILVER ST
Second Line :
City : SILVER CITY
State : NM
Zip : 88061-6779
Country : US
Telephone Number : 575-388-2414
Fax Number : 575-388-2457
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2007
Last Update Date : 08/08/2013

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Directions to “ SUSANNE KEE LISW” Practice Location

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