Provider Information for 1366757304
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PATRICIA DIANE FORDYCE-MONTANARI LMHC
Sex: Female
NPI: 1366757304
Last Updated: 2010-08-14
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1366757304 | ||||||||
| Enumeration Date | 2010-08-14 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 1362 AZTEC, NM 87410-1362 United States Phone: 505-333-2334 | Fax: | ||||||||
| Primary Practice Address | 11 COUNTY ROAD 2952 AZTEC, NM 87410-9770 United States Phone: 505-333-2334 | Fax: | ||||||||
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