Provider Demographics
NPI:1952802118
Name:LUJAN, GREGORY VINENT (LCSW)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:VINENT
Last Name:LUJAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:GREG
Other - Middle Name:
Other - Last Name:LUJAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:8409 LAS CAMAS RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2338
Mailing Address - Country:US
Mailing Address - Phone:505-288-9646
Mailing Address - Fax:
Practice Address - Street 1:8409 LAS CAMAS RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2338
Practice Address - Country:US
Practice Address - Phone:505-288-9646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-101071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical