Healthcare Provider Details

I. General information

NPI: 1326197237
Provider Name (Legal Business Name): MARIANNE WESTBROOK PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 N FOWLER ST
HOBBS NM
88240-2312
US

IV. Provider business mailing address

2410 N FOWLER
HOBBS NM
88240-6065
US

V. Phone/Fax

Practice location:
  • Phone: 575-392-2040
  • Fax: 575-392-0528
Mailing address:
  • Phone: 505-392-2040
  • Fax: 505-392-0528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberNM#314
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number0014C
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: