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General NPI Number Information
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NPI Number | 1881033231
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Entity Type | Organization
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Legal Business Name | CLINICAL, FORENSIC NERUOPSYCHOLOGIST ASSOCIATES OF NEW MEXICO
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Dates
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Enumeration Date | 06/19/2013
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Last Update Date | 06/19/2013
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Provider Practice Location Address
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Address Line | 3228 LOS ARBOLES AVE NE BLDG. 1-230
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-1962
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Country | US
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Telephone | 505-331-2829
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Fax | 505-821-3365
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Provider Business Mailing Address
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Address Line | 3228 LOS ARBOLES AVE NE BLDG. 1-230
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-1962
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Country | US
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Telephone | 505-331-2829
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Fax | 505-821-3365
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Authorized Official
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Title or Position | DEPARTMENT OF HEALTH PROVIDER
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Name | DR. SHARON KERNEN
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Credential | PH.D.
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Telephone | 505-263-8055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 1130
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License Number State | NM
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