Healthcare Provider Details

I. General information

NPI: 1093882649
Provider Name (Legal Business Name): CHERYL ROMERO BROWN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 MAIN ST NE SUITE A
LOS LUNAS NM
87031-6353
US

IV. Provider business mailing address

1840 GEORGIA ST NE
ALBUQUERQUE NM
87110-5903
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-6176
  • Fax:
Mailing address:
  • Phone: 505-450-8053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0073861
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: