Provider Demographics
NPI:1265260079
Name:BIEBER, PETER MATTHEW (LMSW)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:MATTHEW
Last Name:BIEBER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KEWA PUEBLO HEALTH CORPORATION
Mailing Address - Street 2:85 NM-22
Mailing Address - City:KEWA PUEBLO
Mailing Address - State:NM
Mailing Address - Zip Code:87052
Mailing Address - Country:US
Mailing Address - Phone:505-465-3060
Mailing Address - Fax:
Practice Address - Street 1:KEWA PUEBLO HEALTH CORPORATION
Practice Address - Street 2:85 NM-22
Practice Address - City:KEWA PUEBLO
Practice Address - State:NM
Practice Address - Zip Code:87052
Practice Address - Country:US
Practice Address - Phone:505-465-3060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2023-07891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical