Provider Demographics
NPI:1891090114
Name:PEASE, NANCE (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCE
Middle Name:
Last Name:PEASE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 MONROE ST NE UNIT J99
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1871
Mailing Address - Country:US
Mailing Address - Phone:425-320-9556
Mailing Address - Fax:
Practice Address - Street 1:3301 MONROE ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1860
Practice Address - Country:US
Practice Address - Phone:425-320-9556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC604430271041C0700X
NMC-103011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM02976561Medicaid