Healthcare Provider Details

I. General information

NPI: 1477585990
Provider Name (Legal Business Name): DEBORAH LESLIE KOS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4810 HARDWARE DR NE
ALBUQUERQUE NM
87109-2013
US

IV. Provider business mailing address

4810 HARDWARE DR NE STE 1
ALBUQUERQUE NM
87109-2013
US

V. Phone/Fax

Practice location:
  • Phone: 505-273-4610
  • Fax: 505-255-4717
Mailing address:
  • Phone: 505-289-1392
  • Fax: 855-929-4848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number0042C
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: