Healthcare Provider Details

I. General information

NPI: 1609034677
Provider Name (Legal Business Name): CELINDA LEVY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11024 MONTGOMERY BLVD NE POST MAILBOX 366
ALBUQUERQUE NM
87111-3962
US

IV. Provider business mailing address

10805 TRANQUILO RD NE
ALBUQUERQUE NM
87111-6939
US

V. Phone/Fax

Practice location:
  • Phone: 505-449-8396
  • Fax:
Mailing address:
  • Phone: 505-449-8396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number645
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: