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4141 Montgomery Blvd Ne Albuquerque NM 87109-6741 | |
| (505) 560-2804 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 4141 Montgomery Blvd Ne, Albuquerque, New Mexico |
| Authorized Official Name and Position | Tatia O Harris-lipe (OWNER/CEO) |
| Authorized Official Contact | 5753178717 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
6424 Avenida Seville Nw Albuquerque NM 87114-3765 Ph: (575) 317-8717 | 4141 Montgomery Blvd Ne Albuquerque NM 87109-6741 Ph: (505) 560-2804 |
| NPI Number | 1720226590 |
|---|---|
| Provider Enumeration Date | 02/01/2009 |
| Last Update Date | 09/15/2022 |
| Certification Date | 09/15/2022 |
| Medicare PECOS PAC ID | 4385090612 |
|---|---|
| Medicare Enrollment ID | O20231024000044 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720226590 | NPI | - | NPPES |
| Provider Name | Tatia Lipe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205080983 PECOS PAC ID: 8224403266 Enrollment ID: I20230405001494 |
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