Healthcare Provider Details

I. General information

NPI: 1538344296
Provider Name (Legal Business Name): ELLEN LEFKOWITZ, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 DON GASPAR AVE
SANTA FE NM
87505-2626
US

IV. Provider business mailing address

532 DON GASPAR AVE
SANTA FE NM
87505-2626
US

V. Phone/Fax

Practice location:
  • Phone: 505-660-6140
  • Fax: 505-216-2593
Mailing address:
  • Phone: 505-660-6140
  • Fax: 505-216-2593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberI-0912
License Number StateNM

VIII. Authorized Official

Name: MS. ELLEN LEFKOWITZ
Title or Position: OWNER
Credential: LISW
Phone: 505-660-6140