Provider Demographics
NPI:1679691950
Name:RIGGS, HAZEL JEAN (LISW)
Entity type:Individual
Prefix:MRS
First Name:HAZEL
Middle Name:JEAN
Last Name:RIGGS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6117 PARKTREE PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-7202
Mailing Address - Country:US
Mailing Address - Phone:505-822-1622
Mailing Address - Fax:505-260-9934
Practice Address - Street 1:1330 SAN PEDRO DR NE
Practice Address - Street 2:#201-B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6744
Practice Address - Country:US
Practice Address - Phone:505-260-9912
Practice Address - Fax:505-260-9934
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-061811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10020781OtherLOVELACE