Provider Demographics
NPI:1285852921
Name:GRIEGO, LEONA V (SW)
Entity Type:Individual
Prefix:
First Name:LEONA
Middle Name:V
Last Name:GRIEGO
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 1:900 ATLANTIC AVE SW
Mailing Address - Street 2:DOLORES GONZALES ES
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-4014
Mailing Address - Country:US
Mailing Address - Phone:505-764-2020
Mailing Address - Fax:
Practice Address - Street 1:900 ATLANTIC AVE SW
Practice Address - Street 2:DOLORES GONZALES ES
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-4014
Practice Address - Country:US
Practice Address - Phone:505-764-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI 36391041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMB 8635Medicaid