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Individual

CYNTHIA Y PETERSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPCC

Contact information

Practice address
PMG CEDAR PEDIATRIC ENDOCRINOLOGY, 201 CEDAR SE SUITE 4640, ALBUQUERQUE, NM 87106
(505) 563-6530
(505) 563-6325
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-5356
(505) 923-5354

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
3737
NM
101YP2500X
Professional Counselor
Primary
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
97037265
NM
Enumeration date
04/23/2007
Last updated
08/12/2014
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