Provider Demographics
NPI:1215260674
Name:DESIDERIO, ANNE MARIE (LPCC)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:DESIDERIO
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 INDIAN SCHOOL RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1143
Mailing Address - Country:US
Mailing Address - Phone:505-268-4973
Mailing Address - Fax:505-268-5056
Practice Address - Street 1:3500 INDIAN SCHOOL RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1143
Practice Address - Country:US
Practice Address - Phone:505-268-4973
Practice Address - Fax:505-268-5056
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0754101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health