Healthcare Provider Details

I. General information

NPI: 1124331384
Provider Name (Legal Business Name): GABRIELLE FELLIG SARFATY L.P.C.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 EUBANK SE, MS1032
ALBUQUERQUE NM
87185-1032
US

IV. Provider business mailing address

13208 DELLA LONGA LN NE
ALBUQUERQUE NM
87111-2936
US

V. Phone/Fax

Practice location:
  • Phone: 505-845-9704
  • Fax: 505-844-4091
Mailing address:
  • Phone: 505-845-9704
  • Fax: 505-844-4091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0132851
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: