Provider Demographics
NPI:1881033231
Name:CLINICAL, FORENSIC NERUOPSYCHOLOGIST ASSOCIATES OF NEW MEXICO
Entity Type:Organization
Organization Name:CLINICAL, FORENSIC NERUOPSYCHOLOGIST ASSOCIATES OF NEW MEXICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPARTMENT OF HEALTH PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:KERNEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-263-8055
Mailing Address - Street 1:3228 LOS ARBOLES AVE NE
Mailing Address - Street 2:BLDG. 1-230
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1962
Mailing Address - Country:US
Mailing Address - Phone:505-331-2829
Mailing Address - Fax:505-821-3365
Practice Address - Street 1:3228 LOS ARBOLES AVE NE
Practice Address - Street 2:BLDG. 1-230
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1962
Practice Address - Country:US
Practice Address - Phone:505-331-2829
Practice Address - Fax:505-821-3365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1130103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty