Healthcare Provider Details

I. General information

NPI: 1417425083
Provider Name (Legal Business Name): MEREDITH LYNN FAITH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2018
Last Update Date: 11/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11109 ELVIN AVE NE
ALBUQUERQUE NM
87112-3231
US

IV. Provider business mailing address

11109 ELVIN AVE NE
ALBUQUERQUE NM
87112-3231
US

V. Phone/Fax

Practice location:
  • Phone: 505-850-7845
  • Fax:
Mailing address:
  • Phone: 505-850-7845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0947
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number294802
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: