Healthcare Provider Details

I. General information

NPI: 1699883702
Provider Name (Legal Business Name): MARTHA L FIEDLER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 WELLESLEY DRIVE SE
ALBUQUERQUE NM
87106-1443
US

IV. Provider business mailing address

121 WELLESLEY DRIVE SE
ALBUQUERQUE NM
87106-1443
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-0025
  • Fax: 505-266-0023
Mailing address:
  • Phone: 505-266-0025
  • Fax: 505-266-0023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number164
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: