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General NPI Number Information
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NPI Number | 1366258386
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Entity Type | Organization
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Legal Business Name | ROOTS OF RESILIENCE CHILD AND FAMILY CENTER LLC
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 7809 RIDGEVIEW DR NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-2880
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Country | US
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Telephone | 505-585-1378
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 65264
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City | ALBUQUERQUE
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State | NM
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Zip | 87193-5264
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Country | US
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Telephone | 505-585-1348
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Fax |
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Authorized Official
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Title or Position | PSYD
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Name | MARY BALDWIN
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Credential |
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Telephone | 505-221-1746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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