Provider Demographics
NPI:1821493503
Name:MILTON C. LASOSKI, PH.D, LLC
Entity Type:Organization
Organization Name:MILTON C. LASOSKI, PH.D, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:C
Authorized Official - Last Name:LASOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-266-3070
Mailing Address - Street 1:4253 MONTGOMERY BLVD NE
Mailing Address - Street 2:STE 220
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1106
Mailing Address - Country:US
Mailing Address - Phone:505-266-3070
Mailing Address - Fax:
Practice Address - Street 1:4253 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE 220
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1106
Practice Address - Country:US
Practice Address - Phone:505-342-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM364103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM311220OtherPTAN