Provider Demographics
NPI:1134108079
Name:LEFKOWITZ, ELLEN (MSW LISW)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:LEFKOWITZ
Suffix:
Gender:F
Credentials:MSW LISW
Other - Prefix:MS
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:ENGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:532 DON GASPAR AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2626
Mailing Address - Country:US
Mailing Address - Phone:505-984-0895
Mailing Address - Fax:
Practice Address - Street 1:532 DON GASPAR AVE
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2626
Practice Address - Country:US
Practice Address - Phone:505-984-0895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI0912104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00NM01R676OtherBCBS
NM00NM01R676OtherBCBS