Provider Demographics
NPI:1740850148
Name:THOMAS, STEPHANIE (MSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4502 OVERLAND ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2673
Mailing Address - Country:US
Mailing Address - Phone:505-459-0434
Mailing Address - Fax:
Practice Address - Street 1:9301 INDIAN SCHOOL RD NE STE 107
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2864
Practice Address - Country:US
Practice Address - Phone:505-358-5059
Practice Address - Fax:505-521-5167
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty