Provider Demographics
NPI:1366401994
Name:STEARNS, FEDERICK (LISW)
Entity type:Individual
Prefix:
First Name:FEDERICK
Middle Name:
Last Name:STEARNS
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4253 MONTGOMERY BLVD NE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1106
Mailing Address - Country:US
Mailing Address - Phone:505-342-0400
Mailing Address - Fax:505-342-0500
Practice Address - Street 1:4253 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE 2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1106
Practice Address - Country:US
Practice Address - Phone:505-342-0400
Practice Address - Fax:505-342-0500
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNMI0955104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM96145Medicaid