| Meditelecare Of New Mexico, Llc | |
|
206 S Coronado Ave Espanola NM 87532-2792 | |
| (860) 788-6404 | |
| (860) 829-0495 |
| Full Name | Meditelecare Of New Mexico, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 206 S Coronado Ave, Espanola, New Mexico |
| Authorized Official Name and Position | Andrea Godfrey (CREDENTIALING & ENROLLMENT MANAGER) |
| Authorized Official Contact | 8607886404 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Meditelecare Of New Mexico, Llc Po Box 1595 Middletown CT 06457-8095 Ph: (860) 788-6404 | Meditelecare Of New Mexico, Llc 206 S Coronado Ave Espanola NM 87532-2792 Ph: (860) 788-6404 |
| NPI Number | 1629639729 |
|---|---|
| Provider Enumeration Date | 06/28/2019 |
| Last Update Date | 09/04/2024 |
| Certification Date | 09/04/2024 |
| Medicare PECOS PAC ID | 1254668122 |
|---|---|
| Medicare Enrollment ID | O20190815000690 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629639729 | NPI | - | NPPES |
| Provider Name | Keith B Haynie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033355284 PECOS PAC ID: 9436216124 Enrollment ID: I20090325000104 |
| Provider Name | Linda L Hill |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1609837855 PECOS PAC ID: 9436110566 Enrollment ID: I20130918000411 |
| Provider Name | Joseph Alfred Bousquet |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1003982174 PECOS PAC ID: 4688619679 Enrollment ID: I20141212000943 |
| Provider Name | Minda Brown Jaramillo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740495753 PECOS PAC ID: 9638361538 Enrollment ID: I20150819007704 |
| Provider Name | Sherry Young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720167182 PECOS PAC ID: 5991705584 Enrollment ID: I20170615002010 |
| Provider Name | Glenna Rae Tolley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720254816 PECOS PAC ID: 8628141355 Enrollment ID: I20190907000200 |
| Provider Name | Wilfredo Morges |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871007377 PECOS PAC ID: 8729347257 Enrollment ID: I20190917003512 |
| Provider Name | Sandra Jensen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1003975467 PECOS PAC ID: 1456442078 Enrollment ID: I20191017000728 |
| Provider Name | Meeraben Majmudar |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1922372077 PECOS PAC ID: 9436432630 Enrollment ID: I20191203001139 |
| Provider Name | Michael Hewett |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467472480 PECOS PAC ID: 0244275014 Enrollment ID: I20200122001571 |
| Provider Name | Jane Berger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831557891 PECOS PAC ID: 6406286954 Enrollment ID: I20200423002038 |
| Provider Name | Amy Susan Debernardi |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1336388198 PECOS PAC ID: 3274964275 Enrollment ID: I20200506003306 |
| Provider Name | Carey Reed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962944926 PECOS PAC ID: 3678841202 Enrollment ID: I20200602001798 |
| Provider Name | Cynthia A Ziemer |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1003039074 PECOS PAC ID: 9335394659 Enrollment ID: I20201106000087 |
| Provider Name | Violet Ashu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881278240 PECOS PAC ID: 0941697072 Enrollment ID: I20220420000806 |
| Provider Name | Ijeoma Uchegbu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336648625 PECOS PAC ID: 9638550155 Enrollment ID: I20220801000928 |
| Provider Name | Glenn Ferguson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1922391994 PECOS PAC ID: 3870771496 Enrollment ID: I20230104001480 |
| Provider Name | Lovette A Ndubisi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225734601 PECOS PAC ID: 3779922042 Enrollment ID: I20240419000017 |
Peak Behavioral Health Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 1316 Calle Adelante, Espanola, NM 87532 Phone: 575-589-6720 | |
Superhealth, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 19 Lumbre Del Sol, Espanola, NM 87532 Phone: 505-699-6505 | |
Rio Arriba County Hhs Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2010 Industrial Park Rd, Espanola, NM 87532 Phone: 505-753-3143 | |
Guillermina Osoria Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 424 S Riverside Dr Ste G, Espanola, NM 87532 Phone: 505-595-4848 Fax: 888-504-0115 | |
Time 4 Change, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 19525 Tomas Lane, Espanola, NM 87532 Phone: 505-709-0608 | |
Crisis Center Of Nnm Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 577 El Llano Rd, Espanola, NM 87532 Phone: 505-753-1656 Fax: 505-753-7743 | |
Simran Center For Health & Psychology Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 27 Shady Ln, Espanola, NM 87532 Phone: 505-753-4692 |