| Tomas R. Granados, Psy.d. | |
|
7000 Jefferson St Ne Albuquerque NM 87109-4313 | |
| (505) 797-0810 | |
| (505) 797-0814 |
| Full Name | Tomas R. Granados, Psy.d. |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 7000 Jefferson St Ne, Albuquerque, New Mexico |
| Authorized Official Name and Position | Tomas Refugio Granados (OWNER) |
| Authorized Official Contact | 5057970810 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tomas R. Granados, Psy.d. Po Box 93874 Albuquerque NM 87199-3874 Ph: (505) 797-0810 | Tomas R. Granados, Psy.d. 7000 Jefferson St Ne Albuquerque NM 87109-4313 Ph: (505) 797-0810 |
| NPI Number | 1861606246 |
|---|---|
| Provider Enumeration Date | 05/09/2007 |
| Last Update Date | 07/07/2009 |
| Medicare PECOS PAC ID | 7719905967 |
|---|---|
| Medicare Enrollment ID | O20051105000206 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861606246 | NPI | - | NPPES |
| 201011548 | Other | NM | CLINICAL PSYCHOLOGY |
| S8524 | Medicaid | NM | |
| NM00JP49 | Other | NM | CLINICAL PSYCHOLOGY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 702 (New Mexico) | Primary |
| 103TC0700X | Psychologist - Clinical | 702 (New Mexico) | Secondary |
| Provider Name | Tomas R Granados |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1538372479 PECOS PAC ID: 4880678721 Enrollment ID: I20040617000087 |
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