| Liza C Mermelstein Phd Llc | |
|
9426 Indian School Rd Ne Suite 1 Albuquerque NM 87112-2886 | |
| (505) 345-6100 | |
| (505) 345-4531 |
| Full Name | Liza C Mermelstein Phd Llc |
|---|---|
| Speciality | Psychologist |
| Location | 9426 Indian School Rd Ne, Albuquerque, New Mexico |
| Authorized Official Name and Position | Liza Chytilo Mermelstein (MANAGING MEMBER) |
| Authorized Official Contact | 6077689640 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Liza C Mermelstein Phd Llc 9426 Indian School Rd Ne Suite 1 Albuquerque NM 87112-2886 Ph: (505) 345-6100 | Liza C Mermelstein Phd Llc 9426 Indian School Rd Ne Suite 1 Albuquerque NM 87112-2886 Ph: (505) 345-6100 |
| NPI Number | 1710387105 |
|---|---|
| Provider Enumeration Date | 09/04/2014 |
| Last Update Date | 09/04/2014 |
| Medicare PECOS PAC ID | 6002038726 |
|---|---|
| Medicare Enrollment ID | O20141113001680 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710387105 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 1347 (New Mexico) | Primary |
| Provider Name | Liza C Mermelstein |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1679775076 PECOS PAC ID: 7517189244 Enrollment ID: I20141113001917 |
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