| Sea Change Therapy Llc | |
|
712 Valencia Dr Ne Albuquerque NM 87108-1750 | |
| (505) 463-6740 | |
| Not Available |
| Full Name | Sea Change Therapy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 712 Valencia Dr Ne, Albuquerque, New Mexico |
| Authorized Official Name and Position | Fernando Ortiz (CREDENTIALING MANAGER) |
| Authorized Official Contact | 5757078150 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sea Change Therapy Llc 712 Valencia Dr Ne Albuquerque NM 87108-1750 Ph: () - | Sea Change Therapy Llc 712 Valencia Dr Ne Albuquerque NM 87108-1750 Ph: (505) 463-6740 |
| NPI Number | 1518648401 |
|---|---|
| Provider Enumeration Date | 07/25/2023 |
| Last Update Date | 07/25/2023 |
| Certification Date | 07/25/2023 |
| Medicare PECOS PAC ID | 4688015076 |
|---|---|
| Medicare Enrollment ID | O20240516001481 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518648401 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Catherine Anne Haun |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548553308 PECOS PAC ID: 6901024223 Enrollment ID: I20140828001922 |
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