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General NPI Number Information
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NPI Number | 1477223071
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Entity Type | Organization
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Legal Business Name | MANY RIVERS TRANSITIONAL THERAPY SOLUTIONS LLC
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Dates
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Enumeration Date | 09/15/2021
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 203 W MAIN ST
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City | FARMINGTON
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State | NM
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Zip | 87401-4210
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Country | US
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Telephone | 970-729-1178
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1634
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City | DURANGO
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State | CO
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Zip | 81302-1634
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Country | US
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Telephone | 970-729-1178
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Fax |
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Authorized Official
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Title or Position | OWNER, PRIMARY THERAPIST
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Name | ROBERT M WASSERMAN
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Credential | LCSW C-11881
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Telephone | 970-729-1178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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