Healthcare Provider Details

I. General information

NPI: 1154425619
Provider Name (Legal Business Name): JUDITH B. LAY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 LOMAS BLVD NW
ALBUQUERQUE NM
87104-1234
US

IV. Provider business mailing address

1330 LOMAS BLVD NW
ALBUQUERQUE NM
87104-1234
US

V. Phone/Fax

Practice location:
  • Phone: 505-766-5311
  • Fax:
Mailing address:
  • Phone: 505-766-5311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0152
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: