Provider Demographics
NPI:1376606798
Name:ALBUQUERQUE PUBLIC SCHOOL BOARD OF EDUCATION
Entity Type:Organization
Organization Name:ALBUQUERQUE PUBLIC SCHOOL BOARD OF EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH MENTAL HEALTH
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDRAZA
Authorized Official - Suffix:
Authorized Official - Credentials:MED,EDS
Authorized Official - Phone:505-342-7264
Mailing Address - Street 1:6400 UPTOWN BLVD NE
Mailing Address - Street 2:SUITE 360W
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4204
Mailing Address - Country:US
Mailing Address - Phone:505-855-9808
Mailing Address - Fax:505-855-9862
Practice Address - Street 1:6400 UPTOWN BLVD NE
Practice Address - Street 2:SUITE 360W
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4204
Practice Address - Country:US
Practice Address - Phone:505-855-9808
Practice Address - Fax:505-855-9862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000E7599Medicaid