Healthcare Provider Details

I. General information

NPI: 1649650797
Provider Name (Legal Business Name): ANNA MARIE L DINALLO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 ESCALANTE AVE
ALBUQUERQUE L NM
87104
US

IV. Provider business mailing address

1602 ESCALANTE AVE
ALBUQUERQUE L NM
87104
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-3002
  • Fax:
Mailing address:
  • Phone: 505-247-3002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0174381
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: