Provider Demographics
NPI:1174573877
Name:CURLEY-ROAM, ELLEN M (LISW)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:M
Last Name:CURLEY-ROAM
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 1:12836 LOMAS BLVD NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-6210
Mailing Address - Country:US
Mailing Address - Phone:505-306-6047
Mailing Address - Fax:505-883-3083
Practice Address - Street 1:12836 LOMAS BLVD NE
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-6210
Practice Address - Country:US
Practice Address - Phone:505-306-6047
Practice Address - Fax:505-883-3083
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-064891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS28303Medicare UPIN