Healthcare Provider Details

I. General information

NPI: 1659423663
Provider Name (Legal Business Name): ROXANNE RACHEAL ROMERO LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 BROADWAY BLVD NE STE 103
ALBUQUERQUE NM
87102-2300
US

IV. Provider business mailing address

2555 CERRO PARRIDO RD SE
RIO RANCHO NM
87124-8957
US

V. Phone/Fax

Practice location:
  • Phone: 505-766-9361
  • Fax: 505-766-9157
Mailing address:
  • Phone: 505-617-4691
  • Fax: 505-766-9157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0075631
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: