Healthcare Provider Details

I. General information

NPI: 1609082098
Provider Name (Legal Business Name): RENATE WEWERKA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 CERRILLOS RD SUITE 1001 B
SANTA FE NM
87507-2612
US

IV. Provider business mailing address

2840 PLAZA AMARILLA
SANTA FE NM
87507-6504
US

V. Phone/Fax

Practice location:
  • Phone: 505-470-3324
  • Fax: 505-471-1701
Mailing address:
  • Phone: 505-470-3324
  • Fax: 505-471-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0806
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number0806
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: