Healthcare Provider Details

I. General information

NPI: 1700233517
Provider Name (Legal Business Name): GENE DENNEHY LPCC, LADAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2016
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 CAMINO DE LOS MARQUEZ
SANTA FE NM
87505-1837
US

IV. Provider business mailing address

505 CAMINO DE LOS MARQUEZ
SANTA FE NM
87505-1837
US

V. Phone/Fax

Practice location:
  • Phone: 505-636-5415
  • Fax: 505-204-7049
Mailing address:
  • Phone: 505-636-5415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAD0209021
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0198731
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: