| Brain & Body Rehabilitation Psychotherapy Llc | |
|
3200 Carlisle Blvd Ne Ste 224 Albuquerque NM 87110-1664 | |
| (505) 688-0601 | |
| Not Available |
| Full Name | Brain & Body Rehabilitation Psychotherapy Llc |
|---|---|
| Speciality | Psychologist |
| Location | 3200 Carlisle Blvd Ne Ste 224, Albuquerque, New Mexico |
| Authorized Official Name and Position | Mark Pedrotty (PRESIDENT) |
| Authorized Official Contact | 5056880601 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brain & Body Rehabilitation Psychotherapy Llc 3029 Delano Pl Ne Albuquerque NM 87106-2034 Ph: (505) 688-0601 | Brain & Body Rehabilitation Psychotherapy Llc 3200 Carlisle Blvd Ne Ste 224 Albuquerque NM 87110-1664 Ph: (505) 688-0601 |
| NPI Number | 1023731825 |
|---|---|
| Provider Enumeration Date | 09/26/2022 |
| Last Update Date | 09/26/2022 |
| Certification Date | 09/26/2022 |
| Medicare PECOS PAC ID | 2961844980 |
|---|---|
| Medicare Enrollment ID | O20240522002762 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023731825 | NPI | - | NPPES |
| 35587008 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TR0400X | Psychologist - Rehabilitation | (* (Not Available)) | Primary |
| Provider Name | Mark H Pedrotty |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1205843265 PECOS PAC ID: 4587741087 Enrollment ID: I20080408000718 |
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