Organization
GINA SIMON LISW, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GINA SIMON LISW (PRESIDENT)
(505) 249-8764
Entity
Organization
Contact information
Practice address
2729 MESILLA ST NE, ALBUQUERQUE, NM 87110-3539
(505) 249-8764
Mailing address
2729 MESILLA ST NE, ALBUQUERQUE, NM 87110-3539
(505) 249-8764
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I-3207
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D4495
—
NC
Enumeration date
09/14/2007
Last updated
04/27/2023
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