Provider Demographics
NPI:1609082098
Name:WEWERKA, RENATE (PHD)
Entity Type:Individual
Prefix:DR
First Name:RENATE
Middle Name:
Last Name:WEWERKA
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 1:2840 PLAZA AMARILLA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-6504
Mailing Address - Country:US
Mailing Address - Phone:505-470-3324
Mailing Address - Fax:505-471-1701
Practice Address - Street 1:3600 CERRILLOS RD
Practice Address - Street 2:SUITE 1001 B
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-2612
Practice Address - Country:US
Practice Address - Phone:505-470-3324
Practice Address - Fax:505-471-1701
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0806103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic