Provider Demographics
NPI:1780834861
Name:JEANNETTE ACQUISTO, PH.D., PC
Entity Type:Organization
Organization Name:JEANNETTE ACQUISTO, PH.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:F
Authorized Official - Last Name:ACQUISTO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-888-0555
Mailing Address - Street 1:2811 INDIAN SCHOOL RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1825
Mailing Address - Country:US
Mailing Address - Phone:505-888-0555
Mailing Address - Fax:505-247-3190
Practice Address - Street 1:2811 INDIAN SCHOOL RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1825
Practice Address - Country:US
Practice Address - Phone:505-888-0555
Practice Address - Fax:505-247-3190
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEANNETTE ACQUISTO, PH.D., PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM716103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM201012160OtherPRESBYTERIAN