Provider Demographics
NPI:1063540557
Name:ALEXANDER, IRMA (LMSW)
Entity type:Individual
Prefix:
First Name:IRMA
Middle Name:
Last Name:ALEXANDER
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 1:1616 RICHMOND DR NE
Mailing Address - Street 2:MONTEZUMA ES
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1832
Mailing Address - Country:US
Mailing Address - Phone:505-256-0470
Mailing Address - Fax:
Practice Address - Street 1:1616 RICHMOND DR NE
Practice Address - Street 2:MONTEZUMA ES
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1832
Practice Address - Country:US
Practice Address - Phone:505-256-0470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM 58011041S0200X
NMM 05801104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM64025250Medicaid