Healthcare Provider Details

I. General information

NPI: 1578850954
Provider Name (Legal Business Name): MICHELE IEMOLO PSY.D., BCBA, R-DMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 CARLISLE BLVD NE
ALBUQUERQUE NM
87110-1648
US

IV. Provider business mailing address

4228 SADDLEBACK RD NW
ALBUQUERQUE NM
87114-5665
US

V. Phone/Fax

Practice location:
  • Phone: 505-420-1814
  • Fax: 505-420-1814
Mailing address:
  • Phone: 505-304-5584
  • Fax: 505-212-4412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-13-12717
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1441
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: