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NPI Code Detail

MEDICARE: RICHARD MALCOLM LISW

MEDICARE: RICHARD MALCOLM 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 WorkerI-3878NM

Other Identifiers

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

General Provider Information

NPI Number : 1649304668
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD MALCOLM LISW
Provider Business Mailing Address
First Line : PO BOX 26666
Second Line : PHS PROVIDER ENROLLMENT
City : ALBUQUERQUE
State : NM
Zip : 87125-6666
Country : US
Telephone Number : 505-923-6770
Fax Number : 505-923-5354
Provider Business Practice Location Address
First Line : 5310 SEQUOIA RD NW
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87120-1249
Country : US
Telephone Number : 505-836-7330
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2007
Last Update Date : 09/18/2017

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