Provider Demographics
NPI:1609934108
Name:GHAMMACHI BENNETT, MARY ROSE (LPCC PHD)
Entity Type:Individual
Prefix:
First Name:MARY ROSE
Middle Name:
Last Name:GHAMMACHI BENNETT
Suffix:
Gender:F
Credentials:LPCC PHD
Other - Prefix:
Other - First Name:MARY ROSE
Other - Middle Name:
Other - Last Name:GHAMMACHI BENNETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPCC PHD
Mailing Address - Street 1:425 AMHERST DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106
Mailing Address - Country:US
Mailing Address - Phone:505-265-9662
Mailing Address - Fax:
Practice Address - Street 1:425 AMHERST DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106
Practice Address - Country:US
Practice Address - Phone:505-265-9662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0894101YP2500X, 103T00000X, 103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis