Provider Demographics
NPI:1992474175
Name:CHOWDHURY, SUJANA
Entity type:Individual
Prefix:
First Name:SUJANA
Middle Name:
Last Name:CHOWDHURY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 JUAN TABO BLVD NE STE 121F
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-1869
Mailing Address - Country:US
Mailing Address - Phone:505-225-1849
Mailing Address - Fax:
Practice Address - Street 1:2901 JUAN TABO BLVD NE STE 121F
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1869
Practice Address - Country:US
Practice Address - Phone:505-225-1849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2024-08451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical