Basic Information
| Provider Information | |||||||||
| NPI: | 1174593586 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEUSER | ||||||||
| FirstName: | BART | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 MARBLE NE | ||||||||
| Address2: | BUILDING 2 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871315391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052725022 | ||||||||
| FaxNumber: | 5052723466 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 MARBLE NE | ||||||||
| Address2: | BUILDING 2 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871315391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052725022 | ||||||||
| FaxNumber: | 5052723466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2006 | ||||||||
| LastUpdateDate: | 12/20/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I-4152 | NM | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.