Provider Demographics
NPI:1104103266
Name:CONTICELLI, ANDREW (MA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:CONTICELLI
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52063
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87181-2063
Mailing Address - Country:US
Mailing Address - Phone:505-254-1115
Mailing Address - Fax:
Practice Address - Street 1:12306 MENAUL BLVD NE
Practice Address - Street 2:SUITE, C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1781
Practice Address - Country:US
Practice Address - Phone:505-254-1195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0115971101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional