Provider Demographics
NPI:1447362975
Name:ANDERSON, ANN S (LISW)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:S
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:S
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88202-1000
Mailing Address - Country:US
Mailing Address - Phone:575-626-9727
Mailing Address - Fax:
Practice Address - Street 1:500 N MAIN ST STE 400D&F
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-4729
Practice Address - Country:US
Practice Address - Phone:575-626-9727
Practice Address - Fax:575-208-0780
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI30211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM98057Medicaid