Healthcare Provider Details

I. General information

NPI: 1255476438
Provider Name (Legal Business Name): HARRIET L. SMETTERS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7412 NORTHRIDGE AVE NE
ALBUQUERQUE NM
87109-3057
US

IV. Provider business mailing address

7412 NORTHRIDGE AVE NE
ALBUQUERQUE NM
87109-3057
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-8589
  • Fax:
Mailing address:
  • Phone: 505-884-8589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number588
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number248846
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: