Healthcare Provider Details

I. General information

NPI: 1447895651
Provider Name (Legal Business Name): ALBUQUERQUE NEUROPSYCHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 LOMAS BLVD NW STE C
ALBUQUERQUE NM
87102-1894
US

IV. Provider business mailing address

3212 VISTA DEL SUR ST NW
ALBUQUERQUE NM
87120-1512
US

V. Phone/Fax

Practice location:
  • Phone: 505-431-5861
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE GORMAN
Title or Position: NEUROPSYCHOLOGIST
Credential: PH.D.
Phone: 505-450-7804