Healthcare Provider Details

I. General information

NPI: 1033341748
Provider Name (Legal Business Name): ANTHONY MICHAEL BOCCHICCHIO PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2009
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 HILLRISE CIR
LAS CRUCES NM
88011-4741
US

IV. Provider business mailing address

1250 HILLRISE CIR
LAS CRUCES NM
88011-4741
US

V. Phone/Fax

Practice location:
  • Phone: 575-288-1881
  • Fax: 575-288-1889
Mailing address:
  • Phone: 575-288-1881
  • Fax: 575-288-1889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS016663
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY-2025-0062
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: