Healthcare Provider Details

I. General information

NPI: 1538487590
Provider Name (Legal Business Name): ERIK CRAIG PSYCHOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 05/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 CAMINO ESCONDIDO #3
SANTA FE NM
87501-2761
US

IV. Provider business mailing address

113 CAMINO ESCONDIDO #3
SANTA FE NM
87501-2761
US

V. Phone/Fax

Practice location:
  • Phone: 505-995-9955
  • Fax:
Mailing address:
  • Phone: 505-995-9955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number532
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number3270
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: