Provider Demographics
NPI:1821193590
Name:LOUGHEAD, ANNA MARIE P (LISW)
Entity Type:Individual
Prefix:MS
First Name:ANNA MARIE
Middle Name:P
Last Name:LOUGHEAD
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 1:5800 CANYON VISTA DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-6616
Mailing Address - Country:US
Mailing Address - Phone:505-250-6211
Mailing Address - Fax:505-857-0329
Practice Address - Street 1:5712 OSUNA RD NE STE 6
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2576
Practice Address - Country:US
Practice Address - Phone:505-250-6211
Practice Address - Fax:505-857-0329
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-052901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM81128746Medicaid