Provider Demographics
NPI:1881894699
Name:GINERIS, BETH (MA DOM)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:
Last Name:GINERIS
Suffix:
Gender:F
Credentials:MA DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7510 MONTGOMERY BLVD NE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1500
Mailing Address - Country:US
Mailing Address - Phone:505-266-9604
Mailing Address - Fax:505-323-9696
Practice Address - Street 1:7510 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE 202
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1500
Practice Address - Country:US
Practice Address - Phone:505-266-9604
Practice Address - Fax:505-323-9696
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0831101YM0800X
NM910RX1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM024531OtherNATIONAL CERTIFICATION CO
NM3217OtherNEW MEXICO PSYCHOTHERAPY