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NPI Code Detail

MEDICARE: STACEY ROMICK-IMIG

MEDICARE: STACEY ROMICK-IMIG
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TS0200XSchool Psychologist

General Provider Information

NPI Number : 1053081711
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY ROMICK-IMIG
Provider Business Mailing Address
First Line : 405 HUNTER ST
Second Line :
City : ESPANOLA
State : NM
Zip : 87532-2656
Country : US
Telephone Number : 505-367-3342
Fax Number :
Provider Business Practice Location Address
First Line : 405 HUNTER ST
Second Line :
City : ESPANOLA
State : NM
Zip : 87532-2656
Country : US
Telephone Number : 505-367-3342
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2021
Last Update Date : 09/15/2021

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Directions to “ STACEY ROMICK-IMIG ” Practice Location

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