Active NPI
Mary Miesem, LPCC
- Psychoanalysis Psychologist
- Albuquerque, NM
National Provider Identifier
1083723308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychoanalysis Psychologist
- License
- 731
- Practice address
- PMG Kaseman Behavioral Medicine
1325 Wyoming NE
Albuquerque, NM 87112 - Phone
- (505) 291-5300
- Fax
- (505) 291-5303
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychoanalysis Psychologist | 103TP0814X | 731 | NM | Primary |
Addresses
Primary practice location
PMG Kaseman Behavioral Medicine
1325 Wyoming NE
Albuquerque, NM 87112
Mailing address
PO Box 26666
PHS Provider Enrollment
Albuquerque, NM 87125-6666
Phone (505) 923-5356
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 44157339 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 731 | NM | MD | Advanced Practice Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1218672000000",
"number": "1083723308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 26666",
"address_2": "PHS PROVIDER ENROLLMENT",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871256666",
"telephone_number": "505-923-5356",
"fax_number": "505-923-5354"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "PMG KASEMAN BEHAVIORAL MEDICINE",
"address_2": "1325 WYOMING NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "87112",
"telephone_number": "505-291-5300",
"fax_number": "505-291-5303"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIESEM",
"first_name": "MARY",
"credential": "LPCC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2008-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TP0814X",
"taxonomy_group": "",
"desc": "Psychologist, Psychoanalysis",
"state": "NM",
"license": "731",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "44157339",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.