Provider Demographics
NPI:1669445367
Name:DANEHY, LYSSA MICHELLE (LISW)
Entity Type:Individual
Prefix:MS
First Name:LYSSA
Middle Name:MICHELLE
Last Name:DANEHY
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HOSPITAL LOOP NE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2129
Mailing Address - Country:US
Mailing Address - Phone:505-463-2685
Mailing Address - Fax:866-531-2893
Practice Address - Street 1:101 HOSPITAL LOOP NE
Practice Address - Street 2:SUITE 215
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2129
Practice Address - Country:US
Practice Address - Phone:505-463-2685
Practice Address - Fax:866-531-2893
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-12
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-41331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM22051OtherHSN CREDENTIALLING & VERI
NM68338287Medicaid
NMNM202639Medicaid
NM20278400987107A001OtherTRICARE
NM95266OtherLOVELACE HEALTH PLAN