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General NPI Number Information
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NPI Number | 1780834861
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Entity Type | Organization
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Legal Business Name | JEANNETTE ACQUISTO, PH.D., PC
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Dates
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Enumeration Date | 09/24/2008
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Last Update Date | 09/24/2008
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Provider Practice Location Address
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Address Line | 2811 INDIAN SCHOOL RD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-1825
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Country | US
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Telephone | 505-888-0555
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Fax | 505-247-3190
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Provider Business Mailing Address
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Address Line | 2811 INDIAN SCHOOL RD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-1825
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Country | US
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Telephone | 505-888-0555
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Fax | 505-247-3190
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. JEANNETTE F ACQUISTO
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Credential | PH.D.
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Telephone | 505-888-0555
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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 | 716
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License Number State | NM
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