Healthcare Provider Details

I. General information

NPI: 1477452951
Provider Name (Legal Business Name): OLIVIA AVANZATO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2026
Last Update Date: 11/02/2026
Certification Date: 11/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3655 CARLISLE BLVD NE
ALBUQUERQUE NM
87110-1644
US

IV. Provider business mailing address

1032 COLUMBIA DR NE
ALBUQUERQUE NM
87106-2627
US

V. Phone/Fax

Practice location:
  • Phone: 607-431-0895
  • Fax:
Mailing address:
  • Phone: 607-431-0895
  • Fax:

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: