Healthcare Provider Details

I. General information

NPI: 1003982174
Provider Name (Legal Business Name): JOSEPH ALFRED BOUSQUET MSW, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 09/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE SAN RAFAEL THE COGNITIVE BEHAVORIAL INSTITUTE OF ALBUQUERQUE
ALBUQUERQUE NM
87122
US

IV. Provider business mailing address

ONE SAN RAFAEL THE COGNITIVE BEHAVORIAL INSTITUTE OF ALBUQUERQUE
ALBUQUERQUE NM
87122
US

V. Phone/Fax

Practice location:
  • Phone: 505-832-1600
  • Fax: 505-832-1161
Mailing address:
  • Phone: 505-832-1600
  • Fax: 505-832-1161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number864
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1174
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: