Healthcare Provider Details

I. General information

NPI: 1730984451
Provider Name (Legal Business Name): GILLIAN ALEXA MCCABE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 LADERA RD
SANTA FE NM
87508-8301
US

IV. Provider business mailing address

12004 ZIA RD NE APT E8
ALBUQUERQUE NM
87123-1348
US

V. Phone/Fax

Practice location:
  • Phone: 505-289-7115
  • Fax:
Mailing address:
  • Phone: 312-576-8546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-2025-0004
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: