Provider Demographics
NPI:1265145486
Name:LOVATO, ANTIONETTE (LSAA)
Entity type:Individual
Prefix:
First Name:ANTIONETTE
Middle Name:
Last Name:LOVATO
Suffix:
Gender:F
Credentials:LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SAN PEDRO DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6734
Mailing Address - Country:US
Mailing Address - Phone:505-404-0717
Mailing Address - Fax:
Practice Address - Street 1:1600 SAN PEDRO DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6734
Practice Address - Country:US
Practice Address - Phone:505-404-0417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMCTB-2022-0841OtherLICENSE