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General NPI Number Information
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NPI Number | 1518114537
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Entity Type | Individual
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Provider Name | MARY P ROEMER LMT
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Gender | Female
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Dates
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Enumeration Date | 08/21/2008
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Last Update Date | 08/21/2008
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Provider Practice Location Address
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Address Line | 1301 LUISA ST SUITE F
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City | SANTA FE
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State | NM
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Zip | 87505-7001
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Country | US
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Telephone | 505-469-2757
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Fax |
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Provider Business Mailing Address
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Address Line | 208 CAMINO DE LOS MARQUEZ APT 221
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City | SANTA FE
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State | NM
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Zip | 87505-1803
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Country | US
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Telephone | 505-469-2757
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LMHC # 0107341
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 399
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License Number State | NM
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