Healthcare Provider Details

I. General information

NPI: 1164506077
Provider Name (Legal Business Name): ROBERT ANTHONY MACE SERRATORE LMHC MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROBERTO SERRATORE JR.

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 HOB RD
LOS LUNAS NM
87031-7601
US

IV. Provider business mailing address

10801 MANESS LN SW
ALBUQUERQUE NM
87121-3661
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-3092
  • Fax: 505-865-7721
Mailing address:
  • Phone: 575-693-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: