Individual
RICHARD MALCOLM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LISW
Contact information
Practice address
5310 SEQUOIA RD NW, ALBUQUERQUE, NM 87120-1249
(505) 836-7330
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I-3878
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000S7907
—
NM
Enumeration date
03/14/2007
Last updated
09/18/2017
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