Individual
DIANE R MEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LISW
Contact information
Practice address
2727 SAN PEDRO DR NE, STE 105, ALBUQUERQUE, NM 87110-3373
(505) 232-8404
(505) 884-1625
Mailing address
PO BOX 30024, ALBUQUERQUE, NM 87190-0024
(505) 232-8404
(505) 884-1625
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I-0922
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95616
—
NM
01
—
NMB2204
MEDICARE PROVIDER #
NM
Enumeration date
10/12/2005
Last updated
10/11/2018
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