Craig S Nettleton, PE.D. PSYCHOLOGY

Individual provider Active NPI Clinical Psychologist · Moriarty, NM

NPI 1487874889 · NPPES record last updated Jul 8, 2007

Key facts

NPI: 1487874889
Entity type: Individual (NPI type 1)
Primary specialty: Clinical Psychologist 103TC0700X
License: 502 (NM)
Practice address: 200 Center Street
Moriarty, NM 87035-0000
Phone: (505) 832-5817
Fax: (505) 832-5918
NPI assigned: Apr 26, 2007
Sex: Male
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Moriarty Municipal School Local Education Agency (LEA) · Moriarty, NM · NPI 1679793160

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
502	NM	MD	Hearing Instrument Specialist

Practice roles

Organization	Specialty	Status	New patients
Moriarty Municipal School		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Clinical Psychologist	103TC0700X	502	NM	Yes

Addresses

Primary practice location

200 Center Street
Moriarty, NM 87035-0000

Mailing address

PO Box 2000
Moriarty, NM 87035-2000
Phone (505) 832-5817

Other identifiers

Identifier	Type	State	Issuer
Z1246	Medicaid	NM

Other providers in Moriarty, NM

All providers in Moriarty, NM · Clinical Psychologist in New Mexico

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.