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NPI Code Detail

MEDICARE: MRS. MIRIAM WILLIAMS RYAN LISW

MEDICARE: MRS. MIRIAM WILLIAMS RYAN 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
1104100000XSocial WorkerM 5741NM
21041C0700XClinical Social Worker

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 : 1982733440
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MIRIAM WILLIAMS RYAN LISW
Provider Business Mailing Address
First Line : 901 RIO GRANDE BLVD NW STE G252
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87104-2050
Country : US
Telephone Number : 505-226-6320
Fax Number :
Provider Business Practice Location Address
First Line : 901 RIO GRANDE BLVD NW STE G252
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87104-2050
Country : US
Telephone Number : 505-702-8112
Fax Number : 505-355-2611
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2007
Last Update Date : 10/17/2023

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