Meditelecare Of New Mexico, LLC
Psychiatry & Neurology, Psychiatry in Espanola, NM. Organization (NPI-2).
NPI number1629639729
StatusActive
Last updated in NPPESMay 5, 2025
Details
- NPI
- 1629639729
- Entity type
- Organization (NPI-2)
- Legal business name
- Meditelecare Of New Mexico, LLC
- Organization subpart
- No
- Enumeration date
- Jun 28, 2019
- Certification date
- May 5, 2025
- Last updated
- May 5, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology, Psychiatry | – | – | Yes |
| 103TC0700X | Psychologist, Clinical | – | – | |
| 1041C0700X | Social Worker, Clinical | – | – | |
| 2084P0805X | – | – | ||
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | – | – |
Practice location
206 S Coronado AveEspanola, NM 87532-2792
Phone 860-788-6404
Mailing address
Po Box 1595Middletown, CT 06457-8095
Phone 860-788-6404 · Fax 860-829-0495
Authorized official
Andrea Godfrey
Credentialing & Enrollment Manager
8603986441
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