Healthcare Provider Details

I. General information

NPI: 1396256483
Provider Name (Legal Business Name): A NEW LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 JACKSON ST NE
ALBUQUERQUE NM
87108-1339
US

IV. Provider business mailing address

129 JACKSON ST NE
ALBUQUERQUE NM
87108-1339
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-9393
  • Fax: 505-266-6130
Mailing address:
  • Phone: 505-265-9393
  • Fax: 505-266-6130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DENISE FRIEDMAN
Title or Position: PRESIDENT
Credential: LCSW
Phone: 505-265-9393