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1083723308
MARY MIESEM
ALBUQUERQUE, NM
NPI
1083723308
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
103TP0814X Psychologist, Psychoanalysis
(Licence: NM 731)
Enumeration Date
2006-08-30
Last Update Date
2008-08-14
Business Address
MARY MIESEM LPCC
PMG KASEMAN BEHAVIORAL MEDICINE 1325 WYOMING NE
ALBUQUERQUE, NM 87112
Phone number: 505-291-5300
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Mailing Address
MARY MIESEM LPCC
PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE, NM 87125-6666
Phone number: 505-923-5356
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