Healthcare Provider Details

I. General information

NPI: 1619468493
Provider Name (Legal Business Name): BRYN M NARANJO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2729 TRUMAN ST NE
ALBUQUERQUE NM
87110-3029
US

IV. Provider business mailing address

2729 TRUMAN ST NE
ALBUQUERQUE NM
87110-3029
US

V. Phone/Fax

Practice location:
  • Phone: 505-920-5809
  • Fax:
Mailing address:
  • Phone: 505-920-5809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0194011
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: