Provider Demographics
NPI:1104015858
Name:ROMERO, ALEXANDRA KATHLEEN (PSYD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:KATHLEEN
Last Name:ROMERO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 CONEJO DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6110
Mailing Address - Country:US
Mailing Address - Phone:303-358-7265
Mailing Address - Fax:
Practice Address - Street 1:117 N GUADALUPE ST
Practice Address - Street 2:SUITE D
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-6530
Practice Address - Country:US
Practice Address - Phone:505-570-5824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1448103TC2200X
CO3990103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist