Provider Demographics
NPI:1689732224
Name:BERMUDEZ, REBECCA LYNNE (LISW, RIMHC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNNE
Last Name:BERMUDEZ
Suffix:
Gender:F
Credentials:LISW, RIMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 GRANT AVE STE 221
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-2031
Mailing Address - Country:US
Mailing Address - Phone:505-820-0155
Mailing Address - Fax:505-820-0155
Practice Address - Street 1:128 GRANT AVE STE 221
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2031
Practice Address - Country:US
Practice Address - Phone:505-820-0155
Practice Address - Fax:505-820-0155
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-045911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical