Provider Demographics
NPI:1083673065
Name:DURAN, ROXANNE R (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:R
Last Name:DURAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9426 INDIAN SCHOOL RD NE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2886
Mailing Address - Country:US
Mailing Address - Phone:505-342-0400
Mailing Address - Fax:505-342-0500
Practice Address - Street 1:9426 INDIAN SCHOOL RD NE
Practice Address - Street 2:SUITE 2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2886
Practice Address - Country:US
Practice Address - Phone:505-342-0400
Practice Address - Fax:505-342-0500
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM798103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
105755OtherMHN
NM850407910OtherTRICARE
NM$$$$$$$$$Medicare PIN