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NPI Code Detail

MEDICARE: ASHLEY PARK LCSW

MEDICARE: ASHLEY PARK LCSW
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 WorkerC-11640NM

General Provider Information

NPI Number : 1699633198
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY PARK LCSW
Provider Business Mailing Address
First Line : 800 BRADBURY DR SE STE 116
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87106-4310
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2211 LOMAS BLVD NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87106-2719
Country : US
Telephone Number : 505-985-2309
Fax Number : 505-272-0329
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2026
Last Update Date : 03/12/2026

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Directions to “ ASHLEY PARK LCSW” Practice Location

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