Healthcare Provider Details

I. General information

NPI: 1851966394
Provider Name (Legal Business Name): CROSS RIVER THERAPY NM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARQUETTE AVE NW STE 1200
ALBUQUERQUE NM
87102-5312
US

IV. Provider business mailing address

500 MARQUETTE AVE NW STE 1200
ALBUQUERQUE NM
87102-5312
US

V. Phone/Fax

Practice location:
  • Phone: 919-375-0475
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: STEVEN ZAUDERER
Title or Position: CEO
Credential:
Phone: 919-375-0475