Individual
VYVIAN PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
7441 BARTLETT ST NE STE 1B, ALBUQUERQUE, NM 87109-5916
(505) 433-7466
Mailing address
1855 SMARTY JONES ST SE, ALBUQUERQUE, NM 87123-2398
(505) 702-9080
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
M-11585
NM
1041C0700X
Clinical Social Worker
Primary
SWB-2023-0980
NM
1041C0700X
Clinical Social Worker
X11642
NM
106S00000X
Behavior Technician
—
—
Other
Enumeration date
09/29/2017
Last updated
04/22/2025
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