Provider Demographics
NPI:1326197237
Name:WESTBROOK, MARIANNE (PHD)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:WESTBROOK
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 1:2410 N FOWLER
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-6065
Mailing Address - Country:US
Mailing Address - Phone:505-392-2040
Mailing Address - Fax:505-392-0528
Practice Address - Street 1:2410 N FOWLER ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-2312
Practice Address - Country:US
Practice Address - Phone:575-392-2040
Practice Address - Fax:575-392-0528
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM#314103T00000X
NM0014C103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV81275251Medicaid