Healthcare Provider Details

I. General information

NPI: 1609934108
Provider Name (Legal Business Name): MARY ROSE GHAMMACHI BENNETT LPCC PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ROSE GHAMMACHI BENNETT LPCC PHD

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 AMHERST DR NE
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

425 AMHERST DR NE
ALBUQUERQUE NM
87106
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-9662
  • Fax:
Mailing address:
  • Phone: 505-265-9662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0894
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0894
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number0894
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: