Healthcare Provider Details

I. General information

NPI: 1407055866
Provider Name (Legal Business Name): SYLVIA ACOSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MENAUL BLVD NE CENTER FOR DEVELOPMENT AND DISABILITY
ALBUQUERQUE NM
87107-1851
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4725
  • Fax: 505-272-5280
Mailing address:
  • Phone: 505-272-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1151
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: