Individual
MRS. EYA SOFIA VAN TASSLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1010 LAS LOMAS RD NE, ALBUQUERQUE, NM 87102-2634
(505) 600-1499
Mailing address
PO BOX 367, TIJERAS, NM 87059-0367
(505) 660-9185
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
X-11270
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
X-11270
LMSW PROVISIONAL LICENSE NUMBER
NM
Enumeration date
03/09/2020
Last updated
03/09/2020
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