Individual
MS. BEVERLY ANN WOODBURY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
40 HOB RD, LOS LUNAS, NM 87031-7601
(505) 865-3092
(505) 865-7721
Mailing address
PO BOX 270, PERALTA, NM 87042-0270
(505) 865-6176
(505) 865-3268
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I-04633
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
NM
Enumeration date
08/16/2010
Last updated
08/16/2010
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