Healthcare Provider Details

I. General information

NPI: 1093801623
Provider Name (Legal Business Name): MAXANN SHWARTZ PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 PROSPECT AVE. N.E. SUITE C
ALBUQUERQUE NM
87110
US

IV. Provider business mailing address

13205 MORNING MIST AVE. N.E.
ALBUQUERQUE NM
87111
US

V. Phone/Fax

Practice location:
  • Phone: 505-331-7224
  • Fax:
Mailing address:
  • Phone: 505-797-8915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0922
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number15845
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: