Healthcare Provider Details

I. General information

NPI: 1427795582
Provider Name (Legal Business Name): THE INSTITUTE FOR POSTGRADUATE STUDIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 ST. FRANICS DR. BUILDING B
SANTA FE NM
87505
US

IV. Provider business mailing address

1221 ST. FRANCIS DR. BUILDING B
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-660-1558
  • Fax:
Mailing address:
  • Phone: 505-660-1558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICIA A VELAZQUEZ
Title or Position: TRAINING DIRECTOR
Credential: CP
Phone: 505-660-1558