MEDICARE: DR. MARGE PREFONTAINE PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	00119	NM

General Provider Information

NPI Number	:	1134289226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARGE PREFONTAINE PHD

Provider Business Mailing Address
First Line	:	8505 SAN DIEGO CT NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87122-3622
Country	:	US
Telephone Number	:	505-821-1948
Fax Number	:

Provider Business Practice Location Address
First Line	:	8505 SAN DIEGO CT NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87122-3622
Country	:	US
Telephone Number	:	505-821-1948
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. MARGE PREFONTAINE PHD” Practice Location

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