Provider Demographics
NPI:1205475928
Name:MAES, RENAE BERNADETTE
Entity type:Individual
Prefix:
First Name:RENAE
Middle Name:BERNADETTE
Last Name:MAES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10427 CANTACIELO DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-1461
Mailing Address - Country:US
Mailing Address - Phone:505-681-3245
Mailing Address - Fax:
Practice Address - Street 1:10427 CANTACIELO DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-1461
Practice Address - Country:US
Practice Address - Phone:505-681-3245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician