Provider Demographics
NPI:1477307577
Name:DWYER, PAULETTE ANDREA
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:ANDREA
Last Name:DWYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 AVENIDA MALAGUENA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87506-2193
Mailing Address - Country:US
Mailing Address - Phone:805-660-8350
Mailing Address - Fax:
Practice Address - Street 1:1 AVENIDA MALAGUENA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87506-2193
Practice Address - Country:US
Practice Address - Phone:805-660-8350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMF0202661103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy