Sally Eden Moretti, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1395 Issued in NM

Practice address

5920 Canyon Vista Dr NE
Albuquerque, NM 87111-6621

Phone

(505) 933-1807

Fax

(505) 856-1614

NPI assigned

Oct 23, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Life Change Psychotherapy Institute, PC

  • Professional Counselor
  • Albuquerque, NM
  • NPI 1740409135
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1445558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601424000000",
    "number": "1982076402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5920 CANYON VISTA DR NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871116621",
            "telephone_number": "505-933-1807",
            "fax_number": "505-856-1614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5920 CANYON VISTA DR NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871116621",
            "telephone_number": "505-933-1807",
            "fax_number": "505-856-1614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORETTI",
        "first_name": "SALLY",
        "middle_name": "EDEN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-23",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NM",
            "license": "1395",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12226203",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI TYPE 2",
            "identifier": "1053835710",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Savannah Moreno, RN
• Shantell Divinity Moreno
• Therese Ann Moreno, PLMSW
• Adrian Moretti, M.D.
• Mary Moretti, SLP-CF
• Koralia Jazmin Morfin
• Melvin Morfin
• Jessica Morga
• Angela Renee Morgan, NURSE PRACTITIONER
• Brenda Lynn Morgan, NP

• Clinical Psychologist in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Clinical Psychologist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.