Healthcare Provider Details

I. General information

NPI: 1881916807
Provider Name (Legal Business Name): KELLY MARIE ROBBINS L. I. S. W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 E CIRCLE DR
RUIDOSO DOWNS NM
88346-9545
US

IV. Provider business mailing address

HC 46 BOX 667
RUIDOSO DOWNS NM
88346-9613
US

V. Phone/Fax

Practice location:
  • Phone: 575-378-8985
  • Fax:
Mailing address:
  • Phone: 575-378-8985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-05843
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: