Individual
MS. MAURINE R. RENVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
1330 LOMAS BLVD NW, ALBUQUERQUE, NM 87104-1234
(505) 766-5363
Mailing address
1330 LOMAS BLVD NW, ALBUQUERQUE, NM 87104-1234
(505) 766-5363
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I-3985
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201008219
PRESBYTERIAN HEALTH CARE
NM
05
—
79994
—
NM
05
—
NM101564
—
NM
Enumeration date
07/30/2006
Last updated
09/28/2008
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