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5201 Venice Ave Ne Suite A Albuquerque NM 87113-2337 | |
| (505) 916-2007 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 5201 Venice Ave Ne, Albuquerque, New Mexico |
| Authorized Official Name and Position | Tina Bond (CEO) |
| Authorized Official Contact | 5059162007 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2228 Las Brisas Cir Se Rio Rancho NM 87124-8953 Ph: (505) 916-2007 | 5201 Venice Ave Ne Suite A Albuquerque NM 87113-2337 Ph: (505) 916-2007 |
| NPI Number | 1720495682 |
|---|---|
| Provider Enumeration Date | 07/11/2014 |
| Last Update Date | 04/21/2015 |
| Medicare PECOS PAC ID | 8325260326 |
|---|---|
| Medicare Enrollment ID | O20141106001237 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720495682 | NPI | - | NPPES |
| 684-077-26 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | I-08575 (New Mexico) | Primary |
| Provider Name | Jennifer L Dranberg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194058131 PECOS PAC ID: 0648591701 Enrollment ID: I20150602001450 |
| Provider Name | Patricia B Dehoyos |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770021636 PECOS PAC ID: 1153677026 Enrollment ID: I20180706001580 |
| Provider Name | Michelle Romero |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538472410 PECOS PAC ID: 2163851668 Enrollment ID: I20200404000236 |
| Provider Name | Tracey L Trimble |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083026546 PECOS PAC ID: 3779901871 Enrollment ID: I20200921002875 |
| Provider Name | Amanda L Roark-perez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982197042 PECOS PAC ID: 6507273257 Enrollment ID: I20210325001745 |
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