Healthcare Provider Details

I. General information

NPI: 1972671212
Provider Name (Legal Business Name): A NEW DAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 SAN PEDRO NE
ALBUQUERQUE NM
87110
US

IV. Provider business mailing address

1320 DESERT RIDGE RD SE
RIO RANCHO NM
87124-1445
US

V. Phone/Fax

Practice location:
  • Phone: 505-260-9912
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005631
License Number StateNM

VIII. Authorized Official

Name: DR. JEANNETTE V OTERO
Title or Position: CLINICAL COUNSELOR
Credential: ED.D.
Phone: 505-260-9912