| Milton C. Lasoski, Ph.d, Llc | |
|
4253 Montgomery Blvd Ne Suite 220 Albuquerque NM 87109-1106 | |
| (505) 342-0400 | |
| Not Available |
| Full Name | Milton C. Lasoski, Ph.d, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 4253 Montgomery Blvd Ne, Albuquerque, New Mexico |
| Authorized Official Name and Position | Milton C. Lasoski (REGISTERED AGENT) |
| Authorized Official Contact | 5052663070 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Milton C. Lasoski, Ph.d, Llc 4253 Montgomery Blvd Ne Ste 220 Albuquerque NM 87109-1106 Ph: (505) 266-3070 | Milton C. Lasoski, Ph.d, Llc 4253 Montgomery Blvd Ne Suite 220 Albuquerque NM 87109-1106 Ph: (505) 342-0400 |
| NPI Number | 1821493503 |
|---|---|
| Provider Enumeration Date | 10/24/2014 |
| Last Update Date | 05/17/2016 |
| Medicare PECOS PAC ID | 1658696166 |
|---|---|
| Medicare Enrollment ID | O20150204000468 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821493503 | NPI | - | NPPES |
| 311220 | Other | NM | PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 364 (New Mexico) | Primary |
| Provider Name | Milton C Lasoski |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1306859202 PECOS PAC ID: 6204839269 Enrollment ID: I20150831000650 |
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