Individual
BRECKON N PATCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3100 OAK ST, LAS CRUCES, NM 88005-3425
(575) 323-3354
(575) 523-2299
Mailing address
3100 OAK ST, LAS CRUCES, NM 88005-3425
(575) 323-3354
(575) 523-2299
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C-09262
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
76104753
—
NM
Enumeration date
06/05/2013
Last updated
12/31/2015
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