| Sally Eden Moretti, Psy.d. | |
|
5920 Canyon Vista Dr Ne Albuquerque NM 87111-6621 | |
| (505) 933-1807 | |
| (505) 856-1614 |
| Full Name | Sally Eden Moretti, Psy.d. |
|---|---|
| Speciality | Clinic/Center |
| Location | 5920 Canyon Vista Dr Ne, Albuquerque, New Mexico |
| Authorized Official Name and Position | Sally Eden Moretti (OWNER/PSYCHOLOGIST) |
| Authorized Official Contact | 5059331807 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sally Eden Moretti, Psy.d. 5920 Canyon Vista Dr Ne Albuquerque NM 87111-6621 Ph: (505) 933-1807 | Sally Eden Moretti, Psy.d. 5920 Canyon Vista Dr Ne Albuquerque NM 87111-6621 Ph: (505) 933-1807 |
| NPI Number | 1053835710 |
|---|---|
| Provider Enumeration Date | 08/03/2017 |
| Last Update Date | 09/30/2020 |
| Certification Date | 09/30/2020 |
| Medicare PECOS PAC ID | 3274892401 |
|---|---|
| Medicare Enrollment ID | O20180117000295 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053835710 | NPI | - | NPPES |
| 1982076402 | Other | NPI TYPE 1 - INDIVIDUAL | |
| 12226203 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 1395 (New Mexico) | Primary |
| Provider Name | Sally E Moretti |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1982076402 PECOS PAC ID: 0244599488 Enrollment ID: I20180117000493 |
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