Provider Demographics
NPI:1073058897
Name:GRANADO, LORI (LBSW)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:GRANADO
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 MONTGOMERY BLVD NE APT 2066
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2773
Mailing Address - Country:US
Mailing Address - Phone:505-242-3118
Mailing Address - Fax:505-242-2306
Practice Address - Street 1:1718 YALE BLVD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4286
Practice Address - Country:US
Practice Address - Phone:505-242-3118
Practice Address - Fax:505-242-3062
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMB-096681041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool