Provider Demographics
NPI:1538889464
Name:PARADA, ANITA BERNADETA (PHD, LP, CBIS)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:BERNADETA
Last Name:PARADA
Suffix:
Gender:F
Credentials:PHD, LP, CBIS
Other - Prefix:DR
Other - First Name:ANITA
Other - Middle Name:BERNADETA
Other - Last Name:BIALUNSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, CBIS
Mailing Address - Street 1:1007 N POPE ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-5161
Mailing Address - Country:US
Mailing Address - Phone:515-388-1511
Mailing Address - Fax:
Practice Address - Street 1:1007 N POPE ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5161
Practice Address - Country:US
Practice Address - Phone:515-388-1511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPSY-2022-0053103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical