Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 014435 | NY |
N | 103TC0700X | Clinical Psychologist | 014435 | NY |
Y | 103G00000X | Clinical Psychologist | 014435 | NY |
Y | 103TC0700X | Clinical Psychologist | 014435 | NY |
NPI | 1003971573 |
---|---|
Provider Name | Dr. Connie Kaye Mcneil |
First Address | Albuquerque, NM 87109-1529 |
Second Address | Albuquerque, NM 87109-1529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2006 |
Last Update Date | 09/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
91336309 | (05) | NM |