Healthcare Provider Details

I. General information

NPI: 1710139183
Provider Name (Legal Business Name): LISA PARTYKA-SARETTE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA B. PARTYKA PH.D.

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 EL PASEO RD
LAS CRUCES NM
88001-6008
US

IV. Provider business mailing address

4314 TEWA CT
LAS CRUCES NM
88011-4348
US

V. Phone/Fax

Practice location:
  • Phone: 575-647-8040
  • Fax: 575-526-2834
Mailing address:
  • Phone: 805-451-9866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1019
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY 4988
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: