Healthcare Provider Details

I. General information

NPI: 1720012081
Provider Name (Legal Business Name): MARY BETH HUBERMAN M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 02/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 PASEO DE PERALTA
SANTA FE NM
87501-2233
US

IV. Provider business mailing address

821 1/2 NINITA STREET
SANTA FE NM
87504
US

V. Phone/Fax

Practice location:
  • Phone: 505-986-9633
  • Fax: 505-820-1209
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number005712
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4182
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: