Provider Demographics
NPI:1861540924
Name:NAIMARK, EDWARD SPENCER (PHD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:SPENCER
Last Name:NAIMARK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 PROSPECT PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4332
Mailing Address - Country:US
Mailing Address - Phone:505-883-0836
Mailing Address - Fax:505-888-0477
Practice Address - Street 1:7101 PROSPECT PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4332
Practice Address - Country:US
Practice Address - Phone:505-883-0836
Practice Address - Fax:505-888-0477
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM224103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist