| Pivots Potential Llc | |
|
1209 Mountain Road Pl Ne # 4433 Albuquerque NM 87110-7845 | |
| (240) 457-9505 | |
| Not Available |
| Full Name | Pivots Potential Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1209 Mountain Road Pl Ne # 4433, Albuquerque, New Mexico |
| Authorized Official Name and Position | Vida Lynne Penn Leon (EXECUTIVE OFFICER) |
| Authorized Official Contact | 2404579505 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pivots Potential Llc 1401 Haven Rd Apt B12 Hagerstown MD 21742-3097 Ph: (240) 457-9505 | Pivots Potential Llc 1209 Mountain Road Pl Ne # 4433 Albuquerque NM 87110-7845 Ph: (240) 457-9505 |
| NPI Number | 1073351862 |
|---|---|
| Provider Enumeration Date | 07/17/2024 |
| Last Update Date | 07/17/2024 |
| Certification Date | 07/17/2024 |
| Medicare PECOS PAC ID | 9032642764 |
|---|---|
| Medicare Enrollment ID | O20241101001775 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073351862 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Vida Lynne Penn-leon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225150980 PECOS PAC ID: 6608243639 Enrollment ID: I20241101002014 |
| Provider Name | Elysia Russell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114680071 PECOS PAC ID: 6002341815 Enrollment ID: I20241203000162 |
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