Healthcare Provider Details

I. General information

NPI: 1477731040
Provider Name (Legal Business Name): SUSAN D PORTERFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 BURTON AVE SE
ALBUQUERQUE NM
87106-3002
US

IV. Provider business mailing address

2710 BURTON AVE SE
ALBUQUERQUE NM
87106-3002
US

V. Phone/Fax

Practice location:
  • Phone: 505-930-1573
  • Fax:
Mailing address:
  • Phone: 505-236-8366
  • Fax: 505-865-4739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0131321
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: