Healthcare Provider Details

I. General information

NPI: 1518755891
Provider Name (Legal Business Name): MRS. MARIA EUGENIA DEBLASSIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 LADERA RD
SANTA FE NM
87508-8301
US

IV. Provider business mailing address

13 SOMBRA DE LUNA
ESPANOLA NM
87532-9406
US

V. Phone/Fax

Practice location:
  • Phone: 505-289-7115
  • Fax:
Mailing address:
  • Phone: 936-499-3933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: