Provider Demographics
NPI:1891245189
Name:APRENDAMOS INTERVENTION TEAM PA
Entity Type:Organization
Organization Name:APRENDAMOS INTERVENTION TEAM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PROVENCIO
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:575-526-6682
Mailing Address - Street 1:301 PERKINS DR STE B
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3248
Mailing Address - Country:US
Mailing Address - Phone:575-526-6682
Mailing Address - Fax:575-523-7954
Practice Address - Street 1:301 PERKINS DR STE B
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3248
Practice Address - Country:US
Practice Address - Phone:575-526-6682
Practice Address - Fax:575-523-7954
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APRENDAMOS INTERVENTION TEAM PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1041C0700X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty