Provider Demographics
NPI:1164506077
Name:MACE SERRATORE, ROBERT ANTHONY (LMHC MA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANTHONY
Last Name:MACE SERRATORE
Suffix:
Gender:M
Credentials:LMHC MA
Other - Prefix:
Other - First Name:ROBERTO
Other - Middle Name:
Other - Last Name:SERRATORE
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10801 MANESS LN SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-3661
Mailing Address - Country:US
Mailing Address - Phone:575-693-2345
Mailing Address - Fax:
Practice Address - Street 1:40 HOB RD
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-7601
Practice Address - Country:US
Practice Address - Phone:505-865-3092
Practice Address - Fax:505-865-7721
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health