Healthcare Provider Details

I. General information

NPI: 1356495329
Provider Name (Legal Business Name): PSYCHOLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 INDIAN SCHOOL RD NE STE 200
ALBUQUERQUE NM
87110-4968
US

IV. Provider business mailing address

4801 INDIAN SCHOOL RD NE STE 200
ALBUQUERQUE NM
87110-4968
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number529
License Number StateNM

VIII. Authorized Official

Name: CHARLENE MCIVER
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 505-256-1021