Healthcare Provider Details

I. General information

NPI: 1932157351
Provider Name (Legal Business Name): MELODY LOU LAFRINIERE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 05/07/2012
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 02/20/2008

III. Provider practice location address

2211 LOMAS BLVD NE PSY CONSULTATION
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

PO BOX 441
RESERVE NM
87830-0441
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4763
  • Fax:
Mailing address:
  • Phone: 505-259-6675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0888
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0888
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: