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General NPI Number Information
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NPI Number | 1679825095
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Entity Type | Organization
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Legal Business Name | SYLMA FINE
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Dates
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Enumeration Date | 10/09/2012
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | 6666 4TH ST NW
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City | LOS RANCHOS
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State | NM
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Zip | 87107-6144
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Country | US
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Telephone | 505-553-6381
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 25601
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City | ALBUQUERQUE
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State | NM
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Zip | 87125-0601
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. SYLMA FINE
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Credential | MA, LMFT, LPAT
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Telephone | 505-553-6381
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | NM 0133601
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License Number State | NM
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