1023106432 NPI number — GLORIA J BLEA JOHNSON LCSW

Table of content: SAMANTHA HARRIS (NPI 1922898006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023106432 NPI number — GLORIA J BLEA JOHNSON LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLEA JOHNSON
Provider First Name:
GLORIA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BLEA JOHNSON
Provider Other First Name:
GLORIA
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1023106432
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 70112
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87197-0112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-259-1737
Provider Business Mailing Address Fax Number:
505-448-7925

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PO BOX 70112
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87197-0112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-259-1737
Provider Business Practice Location Address Fax Number:
505-448-7925
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  I-07544 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 49821342 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com