Healthcare Provider Details

I. General information

NPI: 1922332113
Provider Name (Legal Business Name): DENISE NINA LASH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DR SE MSC 116
ALBUQUERQUE NM
87108-5153
US

IV. Provider business mailing address

308 TULANE DR SE
ALBUQUERQUE NM
87106-1416
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax:
Mailing address:
  • Phone: 505-265-1711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1096
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: