Provider Demographics
NPI:1346532199
Name:DARLACH, LUCIA (PHD)
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:
Last Name:DARLACH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 2ND ST SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-4119
Mailing Address - Country:US
Mailing Address - Phone:773-682-0535
Mailing Address - Fax:
Practice Address - Street 1:301 UNSER BLVD NW
Practice Address - Street 2:SW MESA CLINIC
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-1927
Practice Address - Country:US
Practice Address - Phone:505-925-4814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007548103TC2200X, 103TF0000X
NM1266103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily