Provider Demographics
NPI:1336357342
Name:ALBY, GEORGINA G (LMSW)
Entity Type:Individual
Prefix:MS
First Name:GEORGINA
Middle Name:G
Last Name:ALBY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NM
Mailing Address - Zip Code:87413-5271
Mailing Address - Country:US
Mailing Address - Phone:505-634-3564
Mailing Address - Fax:505-634-3584
Practice Address - Street 1:1201 N 1ST ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NM
Practice Address - Zip Code:87413-5271
Practice Address - Country:US
Practice Address - Phone:505-634-3564
Practice Address - Fax:505-634-3584
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-4380174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM98473875Medicaid