Healthcare Provider Details

I. General information

NPI: 1336088806
Provider Name (Legal Business Name): EMBODIED HEART SPACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
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: 505-212-4412
Mailing address:
  • Phone: 505-420-1814
  • Fax: 505-212-4412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHELE IEMOLO
Title or Position: OWNER/PSYCHOLOGIST
Credential: PSYD, R-DMT, BCBA
Phone: 505-420-1814