Healthcare Provider Details

I. General information

NPI: 1194826768
Provider Name (Legal Business Name): LYNN ANN ABEITA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 VASSAR DR NE
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

801 VASSAR DR NE
ALBUQUERQUE NM
87106-2725
US

V. Phone/Fax

Practice location:
  • Phone: 505-248-4081
  • Fax: 505-248-7733
Mailing address:
  • Phone: 505-248-4081
  • Fax: 505-248-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0908
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: