Healthcare Provider Details

I. General information

NPI: 1669107314
Provider Name (Legal Business Name): ROSALIE LIPFERT PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 COYOTE XING
SANTA FE NM
87508-9374
US

IV. Provider business mailing address

102 COYOTE XING
SANTA FE NM
87508-9374
US

V. Phone/Fax

Practice location:
  • Phone: 603-359-2553
  • Fax: 972-736-2271
Mailing address:
  • Phone: 603-359-2553
  • Fax: 972-736-2271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ROSALIE JANE LIPFERT
Title or Position: OWNER, LCSW
Credential: LCSW
Phone: 603-359-2553