Provider Demographics
| NPI: | 1689339855 |
|---|---|
| Name: | BRAIN INJURY ASSOCIATION OF NEW MEXICO |
| Entity Type: | Organization |
| Organization Name: | BRAIN INJURY ASSOCIATION OF NEW MEXICO |
| Other - Org Name: | BRAIN INJURY ALLIANCE OF NEW MEXICO |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | MS |
| Authorized Official - First Name: | MARGOT |
| Authorized Official - Middle Name: | M |
| Authorized Official - Last Name: | FELDVEBEL |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | LCSW |
| Authorized Official - Phone: | 505-328-9448 |
| Mailing Address - Street 1: | 3150 CARLISLE BLVD NE STE 208 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | ALBUQUERQUE |
| Mailing Address - State: | NM |
| Mailing Address - Zip Code: | 87110-1681 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 505-328-9448 |
| Mailing Address - Fax: | 505-340-3764 |
| Practice Address - Street 1: | 3150 CARLISLE BLVD NE STE 208 |
| Practice Address - Street 2: | |
| Practice Address - City: | ALBUQUERQUE |
| Practice Address - State: | NM |
| Practice Address - Zip Code: | 87110-1681 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 505-328-9448 |
| Practice Address - Fax: | 505-340-3764 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2021-11-03 |
| Last Update Date: | 2023-11-21 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty | |
| Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
| No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program | Group - Multi-Specialty | |
| No | 2081P0301X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Brain Injury Medicine | Group - Multi-Specialty |
| No | 2251N0400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology | Group - Multi-Specialty |
| No | 225XN1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Neurorehabilitation | Group - Multi-Specialty |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
| No | 372500000X | Nursing Service Related Providers | Chore Provider | Group - Multi-Specialty | |
| No | 374U00000X | Nursing Service Related Providers | Home Health Aide | Group - Multi-Specialty |
