Provider Demographics
NPI:1457583304
Name:ENGELHARD, LAURIE A
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:ENGELHARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINAIR
Mailing Address - State:NM
Mailing Address - Zip Code:87036-0787
Mailing Address - Country:US
Mailing Address - Phone:505-847-2277
Mailing Address - Fax:505-847-0613
Practice Address - Street 1:105 E PINON ST.
Practice Address - Street 2:
Practice Address - City:MOUNTAINAIR
Practice Address - State:NM
Practice Address - Zip Code:87036-0787
Practice Address - Country:US
Practice Address - Phone:505-847-2277
Practice Address - Fax:505-847-0513
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM10419999X104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker