Provider Demographics
NPI:1710139183
Name:PARTYKA-SARETTE, LISA (PHD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PARTYKA-SARETTE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:B
Other - Last Name:PARTYKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:4314 TEWA CT
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4348
Mailing Address - Country:US
Mailing Address - Phone:805-451-9866
Mailing Address - Fax:
Practice Address - Street 1:2145 EL PASEO RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-6008
Practice Address - Country:US
Practice Address - Phone:575-647-8040
Practice Address - Fax:575-526-2834
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1019103TC0700X
CAPSY 4988103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent