Provider Demographics
NPI:1952460404
Name:MERTA, ROD J (PHD)
Entity Type:Individual
Prefix:MR
First Name:ROD
Middle Name:J
Last Name:MERTA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 N RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TRUTH OR CONSEQUENCES
Mailing Address - State:NM
Mailing Address - Zip Code:87901-9738
Mailing Address - Country:US
Mailing Address - Phone:575-894-4357
Mailing Address - Fax:575-894-4358
Practice Address - Street 1:133 N RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:TRUTH OR CONSEQUENCES
Practice Address - State:NM
Practice Address - Zip Code:87901-9738
Practice Address - Country:US
Practice Address - Phone:575-894-4357
Practice Address - Fax:575-894-4358
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2008-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM542103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0000K0463Medicaid
NM0000K0463Medicaid