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Individual

ANDREW R DUBACH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
11930 MENAUL BLVD NE STE 220A, ALBUQUERQUE, NM 87112-2461
(505) 401-0520
Mailing address
530B HARKLE RD # 100, SANTA FE, NM 87505-4739
(505) 401-0520

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
M-09565
NM
1041C0700X
Clinical Social Worker
Primary
C-10748
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
09004513
NM
Enumeration date
05/26/2016
Last updated
06/03/2019
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