Healthcare Provider Details

I. General information

NPI: 1215260674
Provider Name (Legal Business Name): ANNE MARIE DESIDERIO LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87106-1143
US

IV. Provider business mailing address

3500 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87106-1143
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-4973
  • Fax: 505-268-5056
Mailing address:
  • Phone: 505-268-4973
  • Fax: 505-268-5056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0754
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: