Provider Demographics
NPI:1457391492
Name:HARRISON, BHANU JOY (LISW)
Entity type:Individual
Prefix:MRS
First Name:BHANU
Middle Name:JOY
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4308 CARLISLE BLVD NE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4856
Mailing Address - Country:US
Mailing Address - Phone:505-837-2100
Mailing Address - Fax:505-888-7943
Practice Address - Street 1:4308 CARLISLE BLVD NE
Practice Address - Street 2:SUITE 209
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4856
Practice Address - Country:US
Practice Address - Phone:505-837-2100
Practice Address - Fax:505-888-7943
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI55291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM201047515OtherPRESBYTERIAN HEALTH PLAN
NM02158728Medicaid
NMVNM0130OtherVALVE OPTIONS
NMNM101457OtherVALVE OPTIONS