MEDICARE: IRENE DIAZ MONJE LPC

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	101Y00000X	Counselor	70901	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609851468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE DIAZ MONJE LPC

Provider Business Mailing Address
First Line	:	1100 ARIAS AVE NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87104-2100
Country	:	US
Telephone Number	:	505-242-7552
Fax Number	:	505-272-3466

Provider Business Practice Location Address
First Line	:	2600 MARBLE AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-2058
Country	:	US
Telephone Number	:	505-272-8506
Fax Number	:	505-272-3466

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	07/09/2007

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Directions to “ IRENE DIAZ MONJE LPC” Practice Location

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