Provider Demographics
NPI:1396464772
Name:BARTOSH, TIMOTHY (LMSW)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:BARTOSH
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 SAN MATEO BLVD NE STE B186
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-8409
Mailing Address - Country:US
Mailing Address - Phone:505-226-2839
Mailing Address - Fax:505-295-2559
Practice Address - Street 1:4300 SAN MATEO BLVD NE STE B186
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-8409
Practice Address - Country:US
Practice Address - Phone:505-226-2839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
NMSWB-2024-1305104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM06337767Medicaid