Healthcare Provider Details

I. General information

NPI: 1659384683
Provider Name (Legal Business Name): CHARLENE MCIVER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 INDIAN SCHOOL RD NE SUITE 200
ALBUQUERQUE NM
87110-3970
US

IV. Provider business mailing address

2424 MORROW RD NE
ALBUQUERQUE NM
87106-2520
US

V. Phone/Fax

Practice location:
  • Phone: 505-256-1021
  • Fax: 505-268-7442
Mailing address:
  • Phone: 505-265-0642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number259
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: