Individual
ALBERT AVERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
1201 N 1ST ST, BLOOMFIELD, NM 87413-5271
(505) 634-3500
Mailing address
PO BOX 1666, SHIPROCK, NM 87420-1666
(505) 860-3393
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
Primary
M-10211
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1041S0200X
—
NM
Enumeration date
09/06/2018
Last updated
09/06/2018
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