Healthcare Provider Details

I. General information

NPI: 1245865468
Provider Name (Legal Business Name): BONNIE MARIE CATANACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3136 JEMEZ RD
SANTA FE NM
87507-8004
US

IV. Provider business mailing address

3136 JEMEZ RD
SANTA FE NM
87507-8004
US

V. Phone/Fax

Practice location:
  • Phone: 505-603-1353
  • Fax:
Mailing address:
  • Phone: 505-603-1353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCSA0210251
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: