Active NPI
Alyse Y Moulton, LCSW
- Social Worker
- Albuquerque, NM
National Provider Identifier
1922720523
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- SWB-2022-0251
- Practice address
- 1900 Randolph Rd SE
Albuquerque, NM 87106-4247 - Phone
- (505) 750-4547
- NPI assigned
- Sep 12, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 | SWB-2022-0251 | NM | Primary |
Addresses
Primary practice location
1900 Randolph Rd SE
Albuquerque, NM 87106-4247
Mailing address
1321 E Poplar St
Deming, NM 88030-4807
Phone (575) 546-5951
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 |
|---|---|---|---|
| SWB-2022-0251 | NM | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southwest Regional Education Cooperative | Current | Accepting new patients |
Locations
1321 E Poplar St
Deming, NM 88030
Phone 5755465951 ext. 3005
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Local Education Agency (LEA)
- Deming, NM
- NPI 1114081858
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1662940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662940800000",
"number": "1922720523",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1321 E POPLAR ST",
"city": "DEMING",
"state": "NM",
"postal_code": "880304807",
"telephone_number": "575-546-5951",
"fax_number": "575-546-5994"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 RANDOLPH RD SE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871064247",
"telephone_number": "505-750-4547"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOULTON",
"first_name": "ALYSE",
"middle_name": "Y",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-09-12",
"last_updated": "2022-09-12",
"certification_date": "2022-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NM",
"license": "SWB-2022-0251",
"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 Sep 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.