Individual
LORETTA BIFULCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
904 FAIRVIEW DR., SUITE A, ESPANOLA, NM 87532
(505) 747-1991
Mailing address
314 DON FERNANDO ST, PO DRAWER KK, TAOS, NM 87571
(505) 751-7037
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0090521
NM
Other
Enumeration date
10/12/2006
Last updated
07/08/2007
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