Healthcare Provider Details

I. General information

NPI: 1982750329
Provider Name (Legal Business Name): CONNIE ROMERO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4985 AIRPORT RD
SANTA FE NM
87507-1802
US

IV. Provider business mailing address

4985 AIRPORT RD
SANTA FE NM
87507-1802
US

V. Phone/Fax

Practice location:
  • Phone: 505-424-9789
  • Fax: 505-424-9792
Mailing address:
  • Phone: 505-424-9789
  • Fax: 505-424-9792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM2487
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: