Provider Demographics
NPI:1033248596
Name:TIMMCKE, BARBARA (SW)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:TIMMCKE
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 GUADALUPE TRL NW
Mailing Address - Street 2:TAYLOR MS
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-1121
Mailing Address - Country:US
Mailing Address - Phone:505-898-3666
Mailing Address - Fax:
Practice Address - Street 1:8200 GUADALUPE TRL NW
Practice Address - Street 2:TAYLOR MS
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-1121
Practice Address - Country:US
Practice Address - Phone:505-898-3666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI 42201041S0200X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ 7915Medicaid