Provider Demographics
NPI:1518114537
Name:ROEMER, MARY P (LMT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:P
Last Name:ROEMER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 CAMINO DE LOS MARQUEZ
Mailing Address - Street 2:APT 221
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-1803
Mailing Address - Country:US
Mailing Address - Phone:505-469-2757
Mailing Address - Fax:
Practice Address - Street 1:1301 LUISA ST
Practice Address - Street 2:SUITE F
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7001
Practice Address - Country:US
Practice Address - Phone:505-469-2757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLMHC # 0107341101YM0800X
NM399225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health