Provider Demographics
NPI:1568746436
Name:UNM DEPARTMENT OF PSYCHOLOGY CLINIC
Entity Type:Organization
Organization Name:UNM DEPARTMENT OF PSYCHOLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-277-5164
Mailing Address - Street 1:MSC 02 1675
Mailing Address - Street 2:1820 SIGMA CHI NE
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-277-5164
Mailing Address - Fax:505-277-7519
Practice Address - Street 1:MSC 02 1675
Practice Address - Street 2:1820 SIGMA CHI NE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-277-5164
Practice Address - Fax:505-277-7519
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF NEW MEXICO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health