Healthcare Provider Details

I. General information

NPI: 1821911157
Provider Name (Legal Business Name): NEW MEXICO TRAUMA RECOVERY CENTER FOR COMMUNITY VIOLENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 PICKARD AVE NE
ALBUQUERQUE NM
87110-1533
US

IV. Provider business mailing address

8001 PICKARD AVE NE
ALBUQUERQUE NM
87110-1533
US

V. Phone/Fax

Practice location:
  • Phone: 505-312-2405
  • Fax:
Mailing address:
  • Phone: 505-312-2405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SERENA M SIERRA-FAZIO
Title or Position: FOUNDER/EXECUTIVE DIRECTOR
Credential: B.A
Phone: 505-312-2405