Healthcare Provider Details

I. General information

NPI: 1043378771
Provider Name (Legal Business Name): NANCY HANDMAKER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 01/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3949 CORRALES ROAD SUITE 240
CORRALES NM
87048
US

IV. Provider business mailing address

3949 CORRALES RD SUITE 240
CORRALES NM
87048-9348
US

V. Phone/Fax

Practice location:
  • Phone: 505-897-7755
  • Fax: 505-897-7799
Mailing address:
  • Phone: 505-897-7755
  • Fax: 505-897-7799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number718
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: