State of New Mexico
NPI #1124211404 in Las Vegas, New Mexico
Provider Information
- NPI Number
- 1124211404
- Entity Type
- Organization
- Organization Name
- State of New Mexico
- Primary Specialty
- Psychologist - Psychoanalysis
- Enumeration Date
- Aug 21, 2007
- Last Updated
- Aug 21, 2007
Practice Location
- Address
- 3695 HOT SPRINGS BLVD
- City
- Las Vegas
- State
- New Mexico
- ZIP Code
- 87701-9549
- Phone
- (505) 454-2100
Authorized Official
- Name
- STEVE MARTINEZ
- Title
- INTERIM ADMINISTRATOR
- Phone
- (505) 454-2203
Specialties & Taxonomy Codes
| Specialty |
|---|
| Social Worker - Clinical — Clinical |
| Psychologist - Psychoanalysis — Psychoanalysis |
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