Provider Demographics
NPI:1053835710
Name:COPPER KEY PSYCHOLOGY, LLC
Entity Type:Organization
Organization Name:COPPER KEY PSYCHOLOGY, LLC
Other - Org Name:SALLY EDEN MORETTI, PSY.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:EDEN
Authorized Official - Last Name:MORETTI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:505-933-1807
Mailing Address - Street 1:5920 CANYON VISTA DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-6621
Mailing Address - Country:US
Mailing Address - Phone:505-933-1807
Mailing Address - Fax:505-856-1614
Practice Address - Street 1:5920 CANYON VISTA DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-6621
Practice Address - Country:US
Practice Address - Phone:505-933-1807
Practice Address - Fax:505-856-1614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1395261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1982076402OtherNPI TYPE 1 - INDIVIDUAL
NM12226203Medicaid