Provider Demographics
NPI:1760560924
Name:GABEL, BIRGITTA ALTIK (PHD)
Entity Type:Individual
Prefix:DR
First Name:BIRGITTA
Middle Name:ALTIK
Last Name:GABEL
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 1:1400 CENTRAL AVE SE STE 2300
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4859
Mailing Address - Country:US
Mailing Address - Phone:505-255-1555
Mailing Address - Fax:505-255-1117
Practice Address - Street 1:1400 CENTRAL AVE SE STE 2300
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4859
Practice Address - Country:US
Practice Address - Phone:505-255-1555
Practice Address - Fax:505-255-1117
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0770103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM67361Medicaid