Capitan Therapy & Behavioral Health | |
102 East Smokey Bear Blvd Capitan NM 88316 | |
(505) 273-0982 | |
Not Available |
Full Name | Capitan Therapy & Behavioral Health |
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Speciality | Community/Behavioral Health |
Location | 102 East Smokey Bear Blvd, Capitan, New Mexico |
Authorized Official Name and Position | Robert Wudarzewski (OWNER/ ADMINISTRATOR) |
Authorized Official Contact | 5052730982 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Capitan Therapy & Behavioral Health Po Box 1054 Capitan NM 88316-1054 Ph: (505) 273-0982 | Capitan Therapy & Behavioral Health 102 East Smokey Bear Blvd Capitan NM 88316 Ph: (505) 273-0982 |
NPI Number | 1790301026 |
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Provider Enumeration Date | 06/23/2020 |
Last Update Date | 06/23/2020 |
Certification Date | 06/23/2020 |
Medicare PECOS PAC ID | 6305262593 |
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Medicare Enrollment ID | O20200818004217 |
Identifier | Type | State | Issuer |
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1790301026 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
Provider Name | Cheryl Lynne Moore |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1598320236 PECOS PAC ID: 2961834163 Enrollment ID: I20191108001166 |
Provider Name | Kimberly Denise Wudarzewski |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1720416795 PECOS PAC ID: 5890127021 Enrollment ID: I20191108002415 |
Provider Name | Misty Gay Mcarthur |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1134351513 PECOS PAC ID: 1153725387 Enrollment ID: I20210810000749 |
Provider Name | Zanessa D. Kastler |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1982219002 PECOS PAC ID: 3375940752 Enrollment ID: I20210928001558 |
Provider Name | Kara L Carthel |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1447628664 PECOS PAC ID: 0941577910 Enrollment ID: I20230713003958 |