Healthcare Provider Details

I. General information

NPI: 1689228280
Provider Name (Legal Business Name): BLANCA IDALIA CARO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSC06 3870 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

1300 CENTRAL AVE SW
ALBUQUERQUE NM
87102-2805
US

V. Phone/Fax

Practice location:
  • Phone: 505-277-3136
  • Fax:
Mailing address:
  • Phone: 505-243-0335
  • Fax: 505-216-2623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY1552
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: