Healthcare Provider Details

I. General information

NPI: 1396334272
Provider Name (Legal Business Name): LAURA HILFERTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 12TH ST SW
ALBUQUERQUE NM
87102-2876
US

IV. Provider business mailing address

1101 MEDICAL ARTS AVE NE BLDG 3
ALBUQUERQUE NM
87102-2722
US

V. Phone/Fax

Practice location:
  • Phone: 732-439-3919
  • Fax:
Mailing address:
  • Phone: 732-439-3919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number23-436
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCMH0224321
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: