Healthcare Provider Details

I. General information

NPI: 1205656717
Provider Name (Legal Business Name): JESSICA MORGAN ROMERO INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 MENAUL BLVD NE
ALBUQUERQUE NM
87112-1273
US

IV. Provider business mailing address

3312 EL MALECON RD NW
ALBUQUERQUE NM
87120-2726
US

V. Phone/Fax

Practice location:
  • Phone: 505-803-0762
  • Fax:
Mailing address:
  • Phone: 505-803-0762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: