Healthcare Provider Details

I. General information

NPI: 1750765699
Provider Name (Legal Business Name): RELATIONSHIP CENTER OF NEW MEXICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 S MAIN ST
LAS CRUCES NM
88005-2919
US

IV. Provider business mailing address

1060 S MAIN ST
LAS CRUCES NM
88005-2919
US

V. Phone/Fax

Practice location:
  • Phone: 575-915-2601
  • Fax:
Mailing address:
  • Phone: 575-915-2601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1076
License Number StateNM

VIII. Authorized Official

Name: DR. RICHARD NICASTRO
Title or Position: OWNER/PSYCHOLOGIST
Credential: PH.D.
Phone: 575-915-2601