Healthcare Provider Details

I. General information

NPI: 1457421505
Provider Name (Legal Business Name): AMY L CORTESE MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 ESTAMBRE CT
SANTA FE NM
87508-2204
US

IV. Provider business mailing address

5 ESTAMBRE CT
SANTA FE NM
87508-2204
US

V. Phone/Fax

Practice location:
  • Phone: 505-466-6686
  • Fax:
Mailing address:
  • Phone: 505-466-6686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0085601
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: