Individual
DR. ELIZABETH LOUISE KODITUWAKKU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD - PSYCHOLOGIST
Contact information
Practice address
2300 MENAUL BLVD NE, CENTER FOR DEVELOPMENT AND DISABILITY, ALBUQUERQUE, NM 87107-1851
(505) 272-6157
(505) 925-1722
Mailing address
933 BRADBURY DR SE, SUITE 2222, ALBUQUERQUE, NM 87106-4374
(505) 272-3120
(505) 272-8060
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
511
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40404226
—
NM
Enumeration date
07/12/2006
Last updated
05/01/2012
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