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General NPI Number Information
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NPI Number | 1912144890
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Entity Type | Organization
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Legal Business Name | ROBERT F. KENNEDY SBHC
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Dates
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Enumeration Date | 01/14/2009
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Last Update Date | 01/14/2009
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Provider Practice Location Address
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Address Line | 1511 CENTRAL AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4408
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Country | US
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Telephone | 505-923-3031
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Fax |
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Provider Business Mailing Address
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Address Line | 1511 CENTRAL AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4408
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Country | US
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Telephone | 505-923-3031
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Fax |
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Authorized Official
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Title or Position | SBHC COORDINATOR
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Name | BONNIE KAY KAUFMAN
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Credential | RN
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Telephone | 505-923-3031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 101Y00000X
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 251S00000X
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 104100000X
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License Number State | NM
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