Provider Demographics
NPI:1942339437
Name:NELSON, LINDA A (SW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:NELSON
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12015 TIVOLI AVE NE
Mailing Address - Street 2:JOHN BAKER ES
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-5309
Mailing Address - Country:US
Mailing Address - Phone:505-298-7486
Mailing Address - Fax:
Practice Address - Street 1:12015 TIVOLI AVE NE
Practice Address - Street 2:JOHN BAKER ES
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-5309
Practice Address - Country:US
Practice Address - Phone:505-298-7486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI 01321041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM95013Medicaid