Healthcare Provider Details

I. General information

NPI: 1427143965
Provider Name (Legal Business Name): HOWARD M. OTTENHEIMER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 SAINT MICHAELS DR SUITE, 8
SANTA FE NM
87505-7655
US

IV. Provider business mailing address

6528 BARRANCA DR
COCHITI LAKE NM
87083-6009
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-3639
  • Fax:
Mailing address:
  • Phone: 505-989-3639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number672
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: