Provider Demographics
NPI:1538502323
Name:ANNA E EDER, LISW, LLC
Entity Type:Organization
Organization Name:ANNA E EDER, LISW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:E
Authorized Official - Last Name:EDER
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-974-6706
Mailing Address - Street 1:6041 SEQUOIA RD NW
Mailing Address - Street 2:#A-5
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-3440
Mailing Address - Country:US
Mailing Address - Phone:505-417-5957
Mailing Address - Fax:
Practice Address - Street 1:9301 INDIAN SCHOOL RD NE
Practice Address - Street 2:SUITE 103-B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2884
Practice Address - Country:US
Practice Address - Phone:595-974-6706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-06714251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNMB2493OtherMEDICARE
NM01753746Medicaid