MEDICARE: NATHAN FOX 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
1	1041C0700X	Clinical Social Worker	I-05588	NM

Other Identifiers

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

General Provider Information

NPI Number	:	1710041264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN FOX LISW

Provider Business Mailing Address
First Line	:	216 9TH ST NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-3026
Country	:	US
Telephone Number	:	505-266-0388
Fax Number	:	505-268-1063

Provider Business Practice Location Address
First Line	:	3212 MONTE VISTA BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-2120
Country	:	US
Telephone Number	:	505-203-7676
Fax Number	:	505-243-9261

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	02/04/2009

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Directions to “ NATHAN FOX LISW” Practice Location

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