Provider Demographics
NPI:1568444834
Name:UNIVERSITY OF NEW MEXICO PSYCHIATRIC CENTER
Entity Type:Organization
Organization Name:UNIVERSITY OF NEW MEXICO PSYCHIATRIC CENTER
Other - Org Name:UNM MENTAL HEALTH CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:G
Authorized Official - Last Name:MONIE
Authorized Official - Suffix:
Authorized Official - Credentials:RNC
Authorized Official - Phone:505-272-3041
Mailing Address - Street 1:2600 MARBLE AVENUE NORTHEAST
Mailing Address - Street 2:CONTINUING CARE CLINIC
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-2826
Mailing Address - Fax:505-272-8088
Practice Address - Street 1:2600 MARBLE AVE. N.E.
Practice Address - Street 2:CONTINUING CARE CLINIC
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-2826
Practice Address - Fax:505-272-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR18768261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center