Healthcare Provider Details

I. General information

NPI: 1366123622
Provider Name (Legal Business Name): ROBIN NAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 5TH ST STE 100
SANTA FE NM
87505-5403
US

IV. Provider business mailing address

955 RICHARDS AVE APT 3039
SANTA FE NM
87507-6220
US

V. Phone/Fax

Practice location:
  • Phone: 505-955-0410
  • Fax:
Mailing address:
  • Phone: 650-867-7686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: