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General NPI Number Information
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NPI Number | 1225091184
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Entity Type | Individual
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Provider Name | PETRA JEAN ARMIJO-BERTOLA LISW
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Gender | Female
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Dates
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Enumeration Date | 04/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 101 N 2ND ST
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City | RATON
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State | NM
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Zip | 87740-3803
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Country | US
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Telephone | 505-445-7090
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Fax |
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Provider Business Mailing Address
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Address Line | 1448 TURNESA ST
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City | RATON
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State | NM
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Zip | 87740-4438
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Country | US
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Telephone | 505-445-4258
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I-05318
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License Number State | NM
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