Healthcare Provider Details

I. General information

NPI: 1457602369
Provider Name (Legal Business Name): JON PASZKIEWICZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 3RD ST NW
ALBUQUERQUE NM
87102-1403
US

IV. Provider business mailing address

1201 3RD ST
ALBUQUERQUE NM
87125
US

V. Phone/Fax

Practice location:
  • Phone: 505-256-5283
  • Fax: 505-248-1351
Mailing address:
  • Phone: 505-256-5283
  • Fax: 505-248-1351

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:
Title or Position:
Credential:
Phone: