Healthcare Provider Details

I. General information

NPI: 1124471578
Provider Name (Legal Business Name): HUGS TRUCKS N PONIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2016
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10513 4TH ST NW
ALBUQUERQUE NM
87114-2219
US

IV. Provider business mailing address

10513 4TH STREET NW
ALBUQUERQUE NM
87114
US

V. Phone/Fax

Practice location:
  • Phone: 518-951-9363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JOCELYN FIASCHETTI
Title or Position: BEHAVIORIST
Credential:
Phone: 518-951-9363