Provider Demographics
NPI:1205125143
Name:KOINIS, CHERI (PHD)
Entity type:Individual
Prefix:DR
First Name:CHERI
Middle Name:
Last Name:KOINIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CHERI
Other - Middle Name:
Other - Last Name:NEUSTADTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:933 BRADBURY SE, SUITE 2222
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:505-272-3120
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:1 UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:MSC 09 5040
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-3898
Practice Address - Fax:505-272-9828
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1164103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical