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General NPI Number Information
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NPI Number | 1336088806
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Entity Type | Organization
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Legal Business Name | EMBODIED HEART SPACE, LLC
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Dates
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Enumeration Date | 03/27/2026
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Last Update Date | 03/27/2026
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Provider Practice Location Address
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Address Line | 3415 CARLISLE BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-1648
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Country | US
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Telephone | 505-420-1814
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Fax | 505-212-4412
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Provider Business Mailing Address
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Address Line | 4228 SADDLEBACK RD NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-5665
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Country | US
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Telephone | 505-420-1814
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Fax | 505-212-4412
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | DR. MICHELE IEMOLO
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Credential | PSYD, R-DMT, BCBA
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Telephone | 505-420-1814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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