Provider Demographics
NPI:1033124631
Name:SMARRELLA, LINDA E (LPCC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:E
Last Name:SMARRELLA
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 MILES RD SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-3224
Mailing Address - Country:US
Mailing Address - Phone:505-244-0716
Mailing Address - Fax:505-286-1653
Practice Address - Street 1:2418 MILES RD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-3224
Practice Address - Country:US
Practice Address - Phone:505-244-0716
Practice Address - Fax:505-286-1653
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1052101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM90823010Medicaid