Healthcare Provider Details

I. General information

NPI: 1467850339
Provider Name (Legal Business Name): ALEXANDREA NICOLE GOTTLIEB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 UNIVERSITY BLVD NE
ALBUQUERQUE NM
87102-1710
US

IV. Provider business mailing address

201 PRINCETON DR SE APT B
ALBUQUERQUE NM
87106-2974
US

V. Phone/Fax

Practice location:
  • Phone: 505-842-9911
  • Fax:
Mailing address:
  • Phone: 505-365-3764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2025-0567
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: