Healthcare Provider Details

I. General information

NPI: 1679825095
Provider Name (Legal Business Name): SYLMA FINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6666 4TH ST NW
LOS RANCHOS NM
87107-6144
US

IV. Provider business mailing address

PO BOX 25601
ALBUQUERQUE NM
87125-0601
US

V. Phone/Fax

Practice location:
  • Phone: 505-553-6381
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberNM 0133601
License Number StateNM

VIII. Authorized Official

Name: MS. SYLMA FINE
Title or Position: OWNER
Credential: MA, LMFT, LPAT
Phone: 505-553-6381