MEDICARE: DR. SUSAN SMITH-PIERCE 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	101YM0800X	Mental Health Counselor	0112521	NM

General Provider Information

NPI Number	:	1861516874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN SMITH-PIERCE PHD

Provider Business Mailing Address
First Line	:	4708 ROYENE AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-5834
Country	:	US
Telephone Number	:	505-268-4545
Fax Number	:

Provider Business Practice Location Address
First Line	:	2612 TEXAS ST NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-4684
Country	:	US
Telephone Number	:	505-268-4545
Fax Number	:

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

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	09/14/2009

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