Provider Demographics
NPI:1770707119
Name:FRENCH, DEIDRE A (SW)
Entity type:Individual
Prefix:
First Name:DEIDRE
Middle Name:A
Last Name:FRENCH
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 CAMERO AVE NE
Mailing Address - Street 2:EISENHOWER MS
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1802
Mailing Address - Country:US
Mailing Address - Phone:505-292-2530
Mailing Address - Fax:
Practice Address - Street 1:11001 CAMERO AVE NE
Practice Address - Street 2:EISENHOWER MS
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1802
Practice Address - Country:US
Practice Address - Phone:505-292-2530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM 43151041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM93989849Medicaid