Individual
THERESA ANNETTE BUSTOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LBSW
Contact information
Practice address
1900 ATRISCO DR NW, ALBUQUERQUE, NM 87120-1146
(505) 839-4971
Mailing address
1321 E POPLAR ST, DEMING, NM 88030-4807
(575) 546-5951
(575) 546-5994
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
B-09677
NM
1041S0200X
School Social Worker
308145
NM
Other
Enumeration date
12/04/2019
Last updated
12/04/2019
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