Provider Demographics
NPI:1316052756
Name:WALDORF, VIRGINIA ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:ANN
Last Name:WALDORF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:800 BRADBURY DR SE STE 116
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4310
Mailing Address - Country:US
Mailing Address - Phone:505-272-1476
Mailing Address - Fax:
Practice Address - Street 1:1325 WYOMING BLVD NE
Practice Address - Street 2:PRESBYTERIAN MEDICAL GROUP
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112
Practice Address - Country:US
Practice Address - Phone:505-291-5305
Practice Address - Fax:505-291-5327
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-361103TC0700X
NM749103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical