Individual
ILYSSA BOZZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10052 COORS BLVD NW, ALBUQUERQUE, NM 87114-4020
(505) 459-0025
(505) 899-8372
Mailing address
12276 HIGHWAY 14 N, CEDAR CREST, NM 87008-9400
(505) 730-3644
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SWB-2023-0067
NM
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
51355361
—
NM
Enumeration date
10/02/2018
Last updated
08/01/2023
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