Provider Demographics
NPI:1306062427
Name:JENSEN-DELOIA, PSYD, CHERYL DEAN (PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:DEAN
Last Name:JENSEN-DELOIA, PSYD
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 VALLECITOS DR
Mailing Address - Street 2:
Mailing Address - City:TIJERAS
Mailing Address - State:NM
Mailing Address - Zip Code:87059-7302
Mailing Address - Country:US
Mailing Address - Phone:505-286-9402
Mailing Address - Fax:505-286-9402
Practice Address - Street 1:58 VALLECITOS DR
Practice Address - Street 2:
Practice Address - City:TIJERAS
Practice Address - State:NM
Practice Address - Zip Code:87059-7302
Practice Address - Country:US
Practice Address - Phone:505-286-9402
Practice Address - Fax:505-286-9402
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1180103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist