Healthcare Provider Details

I. General information

NPI: 1407311749
Provider Name (Legal Business Name): WELL PLAY-PLAY THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8102 MENAUL BLVD NE STE A
ALBUQUERQUE NM
87110-4725
US

IV. Provider business mailing address

8102 MENAUL BLVD NE STE A
ALBUQUERQUE NM
87110-4725
US

V. Phone/Fax

Practice location:
  • Phone: 505-582-8960
  • Fax:
Mailing address:
  • Phone: 505-582-8960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS SANFILIPO
Title or Position: OWNER
Credential: MA, LPCC
Phone: 505-435-9696