Active NPI
Stephanie Juddo
- Social Worker
- Albuquerque, NM
National Provider Identifier
1780280297
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- M-10955
- Practice address
- 640 Alcazar SE
Albuquerque, NM 87108 - Phone
- (505) 301-5643
- NPI assigned
- Dec 9, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | M-10955 | NM | Primary |
Addresses
Primary practice location
640 Alcazar SE
Albuquerque, NM 87108
Mailing address
9920 Modesto Avenue NE
Albuquerque, NM 87122
Phone (505) 301-5643
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M-10955 | NM | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607472000000",
"number": "1780280297",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9920 MODESTO AVENUE NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "87122",
"telephone_number": "505-301-5643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "640 ALCAZAR SE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "87108",
"telephone_number": "505-301-5643"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUDDO",
"first_name": "STEPHANIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-12-09",
"last_updated": "2020-12-09",
"certification_date": "2020-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NM",
"license": "M-10955",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.