Provider Demographics
NPI:1821398843
Name:CURLEY-ROAM, LYNETTE A (LISW, REV)
Entity Type:Individual
Prefix:MS
First Name:LYNETTE
Middle Name:A
Last Name:CURLEY-ROAM
Suffix:
Gender:F
Credentials:LISW, REV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4813 GOODRICH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1169
Mailing Address - Country:US
Mailing Address - Phone:505-306-6272
Mailing Address - Fax:505-212-0520
Practice Address - Street 1:12836 LOMAS BLVD NE
Practice Address - Street 2:STE. B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-6210
Practice Address - Country:US
Practice Address - Phone:505-306-6272
Practice Address - Fax:505-212-0520
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI065581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical