MEDICARE: ALEXANDRA KATHLEEN ROMERO PSYD

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
1	103TC2200X	Clinical Child & Adolescent Psychologist	1448	NM
2	103T00000X	Psychologist	3990	CO

General Provider Information

NPI Number	:	1104015858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA KATHLEEN ROMERO PSYD

Provider Business Mailing Address
First Line	:	2100 CONEJO DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-6110
Country	:	US
Telephone Number	:	303-358-7265
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 N GUADALUPE ST
Second Line	:	SUITE D
City	:	SANTA FE
State	:	NM
Zip	:	87501-6530
Country	:	US
Telephone Number	:	505-570-5824
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	02/07/2017

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