Healthcare Provider Details

I. General information

NPI: 1902776719
Provider Name (Legal Business Name): DESERT SAGE NEUROPSYCHOLOGY & PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 CARLISLE BLVD NE
ALBUQUERQUE NM
87110-1648
US

IV. Provider business mailing address

3415 CARLISLE BLVD NE
ALBUQUERQUE NM
87110-1648
US

V. Phone/Fax

Practice location:
  • Phone: 505-373-3522
  • Fax:
Mailing address:
  • Phone: 505-373-3522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: SHANNON LAURA LUNDY
Title or Position: CLINICAL NEUROPSYCHOLOGIST
Credential: PHD
Phone: 505-373-3522