Healthcare Provider Details

I. General information

NPI: 1609188028
Provider Name (Legal Business Name): HOPE KRASNER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5345 WYOMING BLVD NE STE. 101
ALBUQUERQUE NM
87109-3148
US

IV. Provider business mailing address

5345 WYOMING BLVD NE STE. 101
ALBUQUERQUE NM
87109-3148
US

V. Phone/Fax

Practice location:
  • Phone: 505-363-0250
  • Fax:
Mailing address:
  • Phone: 505-363-0250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1136
License Number StateNM

VIII. Authorized Official

Name: HOPE A KRASNER
Title or Position: CHILD & ADOLESCENT THERAPIST
Credential: PSY.D.
Phone: 505-363-0250