Provider Demographics
NPI:1073520367
Name:DENNEDY-FRANK, DAVID P (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:DENNEDY-FRANK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 GALISTEO ST STE M1A
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2110
Mailing Address - Country:US
Mailing Address - Phone:505-988-4131
Mailing Address - Fax:505-992-6145
Practice Address - Street 1:2019 GALISTEO STREET
Practice Address - Street 2:SUITE M1A
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-988-4131
Practice Address - Fax:505-992-6145
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM485103TC0700X
CO902103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM90778839Medicaid
NMN 7056Medicaid