MEDICARE: DR. RENATE WEWERKA PH.D.

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	103TC0700X	Clinical Psychologist	0806	NM
2	103TF0200X	Forensic Psychologist	0806	NM

General Provider Information

NPI Number	:	1609082098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENATE WEWERKA PH.D.

Provider Business Mailing Address
First Line	:	2840 PLAZA AMARILLA
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-6504
Country	:	US
Telephone Number	:	505-470-3324
Fax Number	:	505-471-1701

Provider Business Practice Location Address
First Line	:	3600 CERRILLOS RD
Second Line	:	SUITE 1001 B
City	:	SANTA FE
State	:	NM
Zip	:	87507-2612
Country	:	US
Telephone Number	:	505-470-3324
Fax Number	:	505-471-1701

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	09/11/2025

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Directions to “ DR. RENATE WEWERKA PH.D.” Practice Location

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