Healthcare Provider Details

I. General information

NPI: 1720311079
Provider Name (Legal Business Name): ROSELYN H. RAEL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1337 GUSDORF ROAD SUITES E & F
TAOS NM
87571-5227
US

IV. Provider business mailing address

POST OFFICE BOX 2238
TAOS NM
87571
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-4297
  • Fax: 575-751-7237
Mailing address:
  • Phone: 575-758-4297
  • Fax: 575-751-7237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-4480
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: