Healthcare Provider Details

I. General information

NPI: 1306777859
Provider Name (Legal Business Name): KIERAN RYAN VERDUZCO LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 UNIVERSITY BLVD NE
ALBUQUERQUE NM
87102-1710
US

IV. Provider business mailing address

1645 UNIVERSITY BLVD NE
ALBUQUERQUE NM
87102-1710
US

V. Phone/Fax

Practice location:
  • Phone: 505-542-1383
  • Fax:
Mailing address:
  • Phone: 505-542-1383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: