Healthcare Provider Details

I. General information

NPI: 1235870403
Provider Name (Legal Business Name): DEBORAH SCHRODER LPAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2022
Last Update Date: 04/04/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3502 S CAMINO ATOCHA SPC 51
SANTA FE NM
87507-2795
US

IV. Provider business mailing address

3502 S CAMINO ATOCHA SPC 51
SANTA FE NM
87507-2795
US

V. Phone/Fax

Practice location:
  • Phone: 505-660-4988
  • Fax:
Mailing address:
  • Phone: 505-660-4988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCAT0070491
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: