Provider Demographics
NPI:1689136418
Name:CESAR'S ROOM
Entity Type:Organization
Organization Name:CESAR'S ROOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCESCA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:SHRADY
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-913-0953
Mailing Address - Street 1:120 W SANTA FE AVE APT C
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-8881
Mailing Address - Country:US
Mailing Address - Phone:505-913-0953
Mailing Address - Fax:
Practice Address - Street 1:1421 LUISA ST STE O
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4073
Practice Address - Country:US
Practice Address - Phone:505-913-0953
Practice Address - Fax:505-983-9846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM50226541Medicaid