Provider Demographics
NPI:1134407794
Name:SERAFIN, REBA JUNE (MA, LMHC)
Entity type:Individual
Prefix:MS
First Name:REBA
Middle Name:JUNE
Last Name:SERAFIN
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 ORTEGA RD NW
Mailing Address - Street 2:
Mailing Address - City:LOS RANCHOS
Mailing Address - State:NM
Mailing Address - Zip Code:87114-1424
Mailing Address - Country:US
Mailing Address - Phone:505-220-2449
Mailing Address - Fax:
Practice Address - Street 1:612 ORTEGA RD NW
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87114-1424
Practice Address - Country:US
Practice Address - Phone:505-220-2449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0141091101Y00000X
NM0142441101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor