Provider Demographics
NPI:1932416310
Name:PURCELLA, BARBARA L (LMSW)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:L
Last Name:PURCELLA
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 1:10800 SENATOR DENNIS CHAVEZ BLVD SW
Mailing Address - Street 2:ATRISCO HERITAGE HS
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121
Mailing Address - Country:US
Mailing Address - Phone:505-243-1458
Mailing Address - Fax:
Practice Address - Street 1:10800 SENATOR DENNIS CHAVEZ BLVD SW
Practice Address - Street 2:ATRISCO HERITAGE HS
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121
Practice Address - Country:US
Practice Address - Phone:505-243-1458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNOT KNOWN1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNONE ASSIGNEDMedicaid