Healthcare Provider Details

I. General information

NPI: 1043309404
Provider Name (Legal Business Name): JOHN J. MCCAFFERTY LPCC, LADAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2612 VERMONT ST NE
ALBUQUERQUE NM
87110-4640
US

IV. Provider business mailing address

2612 VERMONT ST NE
ALBUQUERQUE NM
87110-4640
US

V. Phone/Fax

Practice location:
  • Phone: 505-903-9017
  • Fax:
Mailing address:
  • Phone: 505-903-9017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005995
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: