Provider Demographics
NPI:1801204219
Name:FORTEZA, CHARLETTE A (LMHC)
Entity Type:Individual
Prefix:
First Name:CHARLETTE
Middle Name:A
Last Name:FORTEZA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 PASEO DEL PINON
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-9371
Mailing Address - Country:US
Mailing Address - Phone:720-278-9928
Mailing Address - Fax:
Practice Address - Street 1:37 PASEO DEL PINON
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-9371
Practice Address - Country:US
Practice Address - Phone:720-278-9928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2022-0677101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health