Healthcare Provider Details

I. General information

NPI: 1669570248
Provider Name (Legal Business Name): GENE M. SHAPIRO LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1448 S SAINT FRANCIS DR
SANTA FE NM
87505-4038
US

IV. Provider business mailing address

1448 S SAINT FRANCIS DR
SANTA FE NM
87505-4038
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-4502
  • Fax: 505-983-4502
Mailing address:
  • Phone: 505-983-4502
  • Fax: 505-983-4502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6195
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: