Provider Demographics
NPI:1972744480
Name:LOVE, JOHN OLIVER (MSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:OLIVER
Last Name:LOVE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:OLIVER
Other - Last Name:LOVE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:2827 RIO GRANDE BLVD NW
Mailing Address - Street 2:APT 1
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-2972
Mailing Address - Country:US
Mailing Address - Phone:505-265-1711
Mailing Address - Fax:505-767-6020
Practice Address - Street 1:1501 SAN PEDRO DRIVE SE
Practice Address - Street 2:BHCL 116
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-5154
Practice Address - Country:US
Practice Address - Phone:505-265-1711
Practice Address - Fax:505-767-6020
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-047341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical