Healthcare Provider Details

I. General information

NPI: 1982153466
Provider Name (Legal Business Name): NADIA JOSEPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 GIBSON BLVD SE
ALBUQUERQUE NM
87108-4729
US

IV. Provider business mailing address

1 CIVIC PLZ NW
ALBUQUERQUE NM
87102-2109
US

V. Phone/Fax

Practice location:
  • Phone: 505-924-6330
  • Fax:
Mailing address:
  • Phone: 505-610-8824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0162491
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: