Healthcare Provider Details

I. General information

NPI: 1073520367
Provider Name (Legal Business Name): DAVID P DENNEDY-FRANK PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 GALISTEO STREET SUITE M1A
SANTA FE NM
87505
US

IV. Provider business mailing address

2019 GALISTEO ST STE M1A
SANTA FE NM
87505-2110
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-4131
  • Fax: 505-992-6145
Mailing address:
  • Phone: 505-988-4131
  • Fax: 505-992-6145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number485
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: