Provider Demographics
NPI:1457421505
Name:CORTESE, AMY L (MS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:CORTESE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ESTAMBRE CT
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-2204
Mailing Address - Country:US
Mailing Address - Phone:505-466-6686
Mailing Address - Fax:
Practice Address - Street 1:5 ESTAMBRE CT
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-2204
Practice Address - Country:US
Practice Address - Phone:505-466-6686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0085601101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
201079803OtherPRESB H
NMG-9368Medicaid