Individual
BERTHA DE VRIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
201 CEDAR ST SE STE 820, ALBUQUERQUE, NM 87106-4912
(505) 841-1434
(505) 222-2149
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C-09224
NM
Other
Enumeration date
11/14/2016
Last updated
11/14/2016
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