Provider Demographics
NPI:1356976674
Name:ABEYTA, AMANDA (CPSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ABEYTA
Suffix:
Gender:F
Credentials:CPSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:ABEYTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LADAC
Mailing Address - Street 1:6 COUNTY ROAD 96
Mailing Address - Street 2:
Mailing Address - City:CHIMAYO
Mailing Address - State:NM
Mailing Address - Zip Code:87522
Mailing Address - Country:US
Mailing Address - Phone:505-471-4985
Mailing Address - Fax:
Practice Address - Street 1:1160 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-7322
Practice Address - Country:US
Practice Address - Phone:505-983-6158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2024-0276101YA0400X
175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist