Healthcare Provider Details

I. General information

NPI: 1659689164
Provider Name (Legal Business Name): LSALOMONE PHD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1639 BETTS ST NE
ALBUQUERQUE NM
87112-4267
US

IV. Provider business mailing address

1639 BETTS ST NE
ALBUQUERQUE NM
87112
US

V. Phone/Fax

Practice location:
  • Phone: 505-292-9071
  • Fax: 505-275-7184
Mailing address:
  • Phone: 505-292-9071
  • Fax: 505-275-7184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0045
License Number StateNM

VIII. Authorized Official

Name: DR. LINDA SALOMONE
Title or Position: COUNSELOR/OWNER
Credential: PHD
Phone: 505-292-9071