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General NPI Number Information
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NPI Number | 1750722104
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Entity Type | Organization
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Legal Business Name | SANDEEN MAYER LLC
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 07/15/2013
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Provider Practice Location Address
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Address Line | 9426 INDIAN SCHOOL RD NE SUITE 1
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-2886
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Country | US
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Telephone | 505-345-6100
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Fax | 505-345-4531
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Provider Business Mailing Address
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Address Line | 9426 INDIAN SCHOOL RD NE SUITE 1
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-2886
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Country | US
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Telephone | 505-345-6100
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Fax | 505-345-4531
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Authorized Official
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Title or Position | PSYCHOLOGIST, PARTNER IN LLC
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Name | DR. EVELYN ELAINE SANDEEN
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Credential | PH.D.
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Telephone | 505-681-3925
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 748
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License Number State | NM
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