Provider Demographics
NPI:1306859202
Name:LASOSKI, MILTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:
Last Name:LASOSKI
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 1:4253 MONTGOMERY BLVD NE
Mailing Address - Street 2:STE 220
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1106
Mailing Address - Country:US
Mailing Address - Phone:505-342-0400
Mailing Address - Fax:
Practice Address - Street 1:4253 MONTGOMERY BLVD NE
Practice Address - Street 2:STE 220
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1106
Practice Address - Country:US
Practice Address - Phone:505-342-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM364103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN6507Medicare ID - Type Unspecified