Healthcare Provider Details

I. General information

NPI: 1689339855
Provider Name (Legal Business Name): BRAIN INJURY ASSOCIATION OF NEW MEXICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 01/18/2026
Certification Date: 01/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 CARLISLE BLVD NE STE 208
ALBUQUERQUE NM
87110-1681
US

IV. Provider business mailing address

3150 CARLISLE BLVD NE STE 208
ALBUQUERQUE NM
87110-1681
US

V. Phone/Fax

Practice location:
  • Phone: 505-328-9448
  • Fax: 505-340-3764
Mailing address:
  • Phone: 505-328-9448
  • Fax: 505-340-3764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. MARGOT M FELDVEBEL
Title or Position: PRESIDENT
Credential: LCSW
Phone: 505-328-9448