Provider Demographics
NPI:1003982174
Name:BOUSQUET, JOSEPH ALFRED (MSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ALFRED
Last Name:BOUSQUET
Suffix:
Gender:M
Credentials:MSW, PHD
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Other - Last Name:
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Mailing Address - Street 1:ONE SAN RAFAEL
Mailing Address - Street 2:THE COGNITIVE BEHAVORIAL INSTITUTE OF ALBUQUERQUE
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122
Mailing Address - Country:US
Mailing Address - Phone:505-832-1600
Mailing Address - Fax:505-832-1161
Practice Address - Street 1:ONE SAN RAFAEL
Practice Address - Street 2:THE COGNITIVE BEHAVORIAL INSTITUTE OF ALBUQUERQUE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122
Practice Address - Country:US
Practice Address - Phone:505-832-1600
Practice Address - Fax:505-832-1161
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH864103T00000X
NM1174103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RE1631Medicare PIN