MEDICARE: MISS PAMELA SUSAN ALDRIDGE MA, LMFT

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	106H00000X	Marriage & Family Therapist	0079591	NM
2	106H00000X	Marriage & Family Therapist	20075	CA

General Provider Information

NPI Number	:	1316060858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS PAMELA SUSAN ALDRIDGE MA, LMFT

Provider Business Mailing Address
First Line	:	5724 GIOMI PL NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-1264
Country	:	US
Telephone Number	:	505-873-1604
Fax Number	:	505-877-3533

Provider Business Practice Location Address
First Line	:	1710 EL CENTRO FAMILIAR BLVD SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-4502
Country	:	US
Telephone Number	:	505-873-1604
Fax Number	:	505-877-3533

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/08/2007

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