Provider Demographics
NPI:1881187334
Name:UFFENHEIMER, LARA JILL
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:JILL
Last Name:UFFENHEIMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12809 DUNES RD SE APT 1
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-3600
Mailing Address - Country:US
Mailing Address - Phone:240-413-0471
Mailing Address - Fax:
Practice Address - Street 1:12809 DUNES RD SE APT 1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-3600
Practice Address - Country:US
Practice Address - Phone:240-413-0471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-10
Last Update Date:2018-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician